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ABSTRACT Introduction and objectives: The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) and the Interventional Working Group of the Spanish Society of Pediatric Cardiology (GTH-SECPCC) present their annual activity report for 2022. Methods: All Spanish centers with catheterization laboratories and interventional activity in congenital heart diseases were invited to participate. Data were collected online and analyzed by an external company, together with the members of the ACI-SEC and the GTH-SECPCC. Results: A total of 22 centers participated (19 public and 3 private). Interventional data on adult congenital diseases contributed by another 99 hospitals to the Registry of Cardiac Catheterization and Interventional Cardiology of the ACI-SEC in 2022 were incorporated into the analysis. A total of 1141 diagnostic studies (4.3% more than in 2021) and 2508 interventional catheterizations (61.5% more than in 2020) were registered. The most frequent procedures were atrial septal defect closure (1135 cases), percutaneous closure of patent ductus arteriosus (262 cases), and pulmonary branch artery angioplasty (234 cases). The most significant increases in volume were related to balloon aortic valvuloplasty (48.9%), atrial septal defect closure (45.2%), and ventricular septal defect closure (40.7%). Interventional procedures were successful in 97.6%, with major procedural complications occurring in 1.4% and in-hospital mortality in 0.2%. Conclusions: This report is the third publication of the Spanish Cardiac Catheterization in Congenital Heart Diseases Registry. Both diagnostic and interventional procedures substantially increased, particularly in balloon aortic valvuloplasty, atrial septal defect closure, and ventricular septal defect closure. Most interventional techniques continue to demonstrate excellent safety and effectiveness outcomes.

ABSTRACT Introduction and objectives: Although cardiac catheterization (CC) has become a routine practice in pediatric heart transplantation (HT), there is still a shortage of widely used protocols and strong evidence on the number of procedures required and their impact on HT outcomes, as well as the need for further CC. This study aimed to analyze CC activity in pediatric HT recipients in a tertiary center and describe risk factors for a higher number of post-HT procedures. Methods: This retrospective study obtained data from medical reports and image files. The sample was composed of patients with cardiomyopathies and congenital heart diseases (CHD). Risk factor analysis for CCs was conducted with linear regression and the ANOVA test. Results: The sample included 61 children (36.07% with CHD). The CHD group had a higher mean number of CCs prior to HT. The most frequent activities prior to HT were diagnostic catheterizations, followed by endomyocardial biopsies for cardiomyopathies and aortopulmonary collaterals in CHD patients. There were 389 post-HT CCs (608 procedures). Most CCs were performed for rejection surveillance, accounting for 92.75% of procedures. The univentricular CHD subgroup was associated with a higher number of CC after HT (P = .03). Conclusions: Despite long life expectancy, pediatric HT recipients have...

Data on the safety and efficiency of perventricular device closure of complex ventricular septal defects (VSDs) are scarce. We report successful one-stage combined hybrid perventricular and percutaneous closure of the muscular VSDs in a critically ill 4-kg infant, using the new multifunctional occluder.

Dual drainage of a pulmonary vein is an unusual anomaly of pulmonary venous drainage. While being evaluated for hypertension, a child was found with dual drainage of the upper left lobe through a vertical vein that connects to the normal pulmonary vein as well as the innominate vein with no symptoms from his effective left-to-right shunt.

Abstract Background Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) occurring in patients undergoing cardiac catheterization, such as coronary angiography (CAG) or percutaneous coronary intervention (PCI). Although the conventional criterion for CIN detection involves a rise in creatinine levels within 72 h after contrast media injection, several limitations exist in this definition. Up to now, various meta-analyses have been undertaken to assess the accuracy of different biomarkers of CIN prediction. However, the existing body of research lacks a cohesive overview. To address this gap, a comprehensive umbrella review was necessary to consolidate and summarize the outcomes of prior meta-analyses. This umbrella study aimed to offer a current, evidence-based understanding of the prognostic value of biomarkers in predicting CIN. Methods A systematic search of international databases, including PubMed, Scopus, and Web of Science, from inception to December 12, 2023, was conducted to identify meta-analyses assessing biomarkers for CIN prediction. Our own meta-analysis was performed by extracting data from the included studies. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were assessed using Meta-Disc and CMA softwares. Results Twelve studies were ultimately included in the umbrella review. The results revealed that neutrophil gelatinase-associated lipocalin (NGAL) exhibited the highest area under the curve (AUC), followed by cystatin-C, urinary kidney injury molecule-1 (uKIM-1), and brain natriuretic peptide (BNP) with AUCs of 0.91, 0.89, 0.85, and 0.80, respectively. NGAL also demonstrated the highest positive likelihood ratio [effect size (ES): 6.02, 95% CI 3.86–9.40], followed by cystatin-C, uKIM-1, and BNP [ES: 4.35 (95% CI 2.85–6.65), 3.58 (95% CI 2.75–4.66), and 2.85 (95% CI 2.13–3.82), respectively]. uKIM-1 and cystatin-C had the lowest negative likelihood ratio, followed by NGAL and BNP [ES: 0.25 (95% CI 0.17–0.37), ES: 0.25 (95% CI 0.13–0.50), ES: 0.26 (95% CI 0.17–0.41), and ES: 0.39 (0.28–0.53) respectively]. NGAL emerged as the biomarker with the highest diagnostic odds ratio for CIN, followed by cystatin-C, uKIM-1, BNP, gamma-glutamyl transferase, hypoalbuminemia, contrast media volume to creatinine clearance ratio, preprocedural hyperglycemia, red cell distribution width (RDW), hyperuricemia, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), high-sensitivity CRP, and low hematocrit (P

Abstract Background New “noncardiac” problems in children with congenital heart disease (CHD), such as developmental delay or long-term neurodevelopmental impairments, have attracted considerable attention in recent years. It is hypothesized that exercise might attenuate CHD-associated neurodevelopmental impairments; however, this has not been thoroughly investigated. The objective of this prospective, single-blinded, randomized controlled experiment was to evaluate the impact of customized home-based exercise for children with CHD. Methods Children aged 0–5 years with echocardiography-confirmed simple CHD subtypes who were scheduled to undergo cardiac catheterization were screened for enrolment. Among 420 screened CHD children, 192 were enrolled and randomly assigned at a 1:1 ratio to receive a 6-month intervention (30 min daily customized home-based exercise program with supervision for no less than 5 days per week, combined with home-based exercise education) or control treatment (home-based education). The primary outcome was motor development (gross motor quotient (GMQ), fine motor quotient (FMQ), and total motor quotient (TMQ)). The secondary outcomes were cardiac function and structure, bone quality, physical development, parental anxiety, caregiver burden, and quality of life. Children and their families were assessed before and 1, 3, and 6 months after catheterization; 183 (95.3%) children were included in the primary analysis. Results After 6-month treatment, the intervention group significantly increased their motor quotient, which was consistently higher than that of the control group (GMQ p 0.017). For parents, higher quality of life level (total score p = 0.016) was observed in the intervention group; while effects of exercise on the anxiety (rude score p = 0.159, standard score p = 0.159) or the Zarit caregiver burden scale score (p = 0.404) were non-significant. No adverse events occurred during the study period. Conclusions Customized home-based exercise improved motor development in children with CHD. While the long-term effects of parent training in home-based exercise are unknown, the study results suggest positive outcomes. Trial registration A home-based exercise program in congenital heart disease children with cardiac catheterization: a randomized controlled trial. ( http://www.chictr.org.cn/ , ChiCTR-IOR-16007762, January 14, 2016).

ABSTRACT Introduction and objectives: Performing cardiac catheterization can be challenging regarding the management of congenital heart disease. Therefore, the use of risk scoring or grading systems can help us plan the procedure. Back in 2015, the Congenital Cardiac Interventional Study Consortium developed and validated a system called CRISP (Catheterization risk score for pediatrics), which predicted the risk of serious adverse events (SAEs) prior to cardiac catheterization. Our aim was to use and validate the same scoring system to predict SAEs associated with cardiac catheterization in a Spanish pediatric hospital. Methods: A retrospective descriptive study was performed between January 2016 and May 2017. To create the area under the curve, the expected number of events was correlated with the overall number of cases (compared to the original CRISP). Pearson’s chi-square test was used to assess the performance of the scoring system. Results: A total of 516 patients were successfully enrolled, 26.6% of whom were < 1 year-old [range, 1 day to 18 years], 56.5% were males, and 17% weighed < 5 kg. Around 63.3% of the procedures performed were percutaneous compared to 1.2% that were hybrid. A total of 40 SAEs were found to be amenable to immediate correction with no associated mortality. CRISP showed good discrimination with an area under the curve of 0.71 (95%CI, - 0.66-0.91) compared to the original score of 0.74, and adequate goodness of fit with Pearson’s chi-square test of 8.26 (P < .08). Conclusions: Despite the performance of highly complex procedures, the rate of SAEs was similar to the one previously published. CRISP has proven to be a good benchmarking and risk stratification tool. Therefore, it can be successfully used in the Spanish pediatric population and have a positive impact on patient care like helping during pre- and post-catheterization care planning.

Key Clinical Message This is a case of 83 years old male who had radial artery pseudoaneurysm after cardiac catheterization. The diagnosis was through Doppler ultrasound and the patient was treated with thrombin injection and reported good outcomes. The literature also included 41 cases of pseudoaneurysm after catheterization. The mean age of patients was 68.5 years with a male prevalence of 49%. Onset of pseudoaneurysm ranged from 0 days (directly after the catheterization) to 150 days with a median of 5 days. The treatment of patients was mainly surgical (19 cases) followed by compression (either manual or TR band) (12 cases), thrombin injection (four cases), compression then surgery (three cases), compression then thrombin injection (one case), percutaneous endovascular repair using a covered stent (one case) and not reported in one case. All cases recovered well.

Percutaneous mitral valve commissurotomy (PMC) is a viable alternative to mitral valve (MV) surgery in the treatment of patients with rheumatic mitral stenosis (RMS). In this single-center retrospective study of consecutive patients with RMS submitted to PMC from 1991 to 2008, we analyzed clinical, echocardiographic, and hemodynamic data and events during follow-up (FUP) until December 2021. Major adverse cardiovascular events (MACE) were a combined endpoint of all-cause death, cardiovascular hospitalization, and MV re-intervention. A total of 124 patients were enrolled: 108 (87.1%) were female, with a mean age at PMC of 46 [standard deviation (SD) 11] years. PMC was successful in 91.1%, with a mean reduction in invasive transmitral pressure gradient (TMPG) of 8 (SD 7) mmHg at PMC time. During the mean FUP of 20 (SD 6) years, 51 (41.1%) patients had MV re-intervention (86.3% surgery and 13.7% redo-PMC), 37 (29.8%) were hospitalized, and 30 (24.2%) died. Approximately 75% of patients remained MACE-free after 10 years, and this percentage decreased to around 40% after 20 years; at this time mark, about 8 in 10 patients were alive. A reduction of

ABSTRACT Introduction and objectives: This is the 2021 annual activity report from the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC), and the Interventional Working Group of the Spanish Society of Pediatric Cardiology (GTH-SECPCC). Methods: All Spanish centers with cath lab capabilities and interventional activity in congenital heart diseases were invited to participate. Data were collected online, analyzed by an external company, and ACI-SEC and GTH-SECPCC members. Results: A total of 16 centers participated—15 public and 1 private—including 34 cath labs with experience in congenital heart diseases, 7 of them (20.5%) exclusively dedicated to pediatric patients. A total of 1094 diagnostic studies (4.5% more than 2020) and 1553 interventional catheterizations (5.8% more than 2020) were registered. The most common procedures were atrial septal defect closure (336 cases), pulmonary branch artery angioplasty (231 cases), and percutaneous closure of the patent ductus arteriosus (228 cases). Interventional procedures were considered successful in 95% of the cases with rates of major procedural complication and in-hospital mortality of 2.7% and 0.2%, respectively. Conclusions: This is the second Spanish Cardiac Catheterization in Congenital Heart Diseases Registry report. A significant increase of diagnostic and interventional procedures was reported with a special increase of percutaneous valve implantation, ductus arteriosus closure, and aortic angioplasty. Most interventional techniques continue to demonstrate excellent safety and efficacy outcomes.

While still considered a high-risk procedure, cardiac catheterization during the early postoperative period is being performed more frequently in the current era. Limited data are currently available concerning the acute hemodynamic consequences of these procedures. Therefore, the purpose of this study was to evaluate the safety/efficacy of cardiac catheterization performed within thirty days of congenital heart surgery. We completed a retrospective review of all catheterizations within 30 days of congenital heart surgery. Procedures were performed due to failure to progress or hemodynamic deterioration. There were 1873 congenital heart surgeries during the study period. One hundred and three (6.2%) patients with a median age of 124 days underwent catheterization. Sixty-three cases received interventions, and forty patients underwent diagnostic catheterization. Early cardiac catheterization did not show a significant immediate change in the hemodynamics or inotrope score. Survival for patients undergoing diagnostic Cath (81%) did not differ significantly from the intervention group (89%). Although cardiac catheterization was performed on patients at the highest risk for death in the postoperative period, catheter intervention did not increase the risk of death. Those patients undergoing catheter intervention did not seem to experience major adverse events but achieved mild improvement in tissue perfusion.

Key Clinical Message Coronary artery fistula is a rare abnormal connection between the heart arteries. Patients may remain asymptomatic until adulthood, potentially experiencing life‐threatening complications. Adequate monitoring and therapeutic management are essential.

The hemodynamics of anomalous origin of the pulmonary artery (PA) from the aorta is challenging. Different sources of blood supply to the lungs lead to a unique state of differential flow, pressure, and pulmonary vascular resistance in each lung. The decision for surgical reimplantation of the anomalous PA during infancy is easy. The assessment of operability beyond infancy, however, is perplexing. In this report, we describe stepwise multimodal hemodynamic evaluation and successful surgical management in a 15-year-old boy with an isolated anomalous origin of the right PA from the aorta. We also report 5-year hemodynamic data confirming sustained benefit over the long term, thus providing much-needed clinical validation of often cited Poiseuille's and Ohm's laws.

INTRODUCTION: Anterior jugular veins are a paired structure found on either side of the neck and are responsible for other veins in draining the head and neck regions. CASE: The variations reported here are from two male cadavers about 45 and 50 years of age who were being dissected routinely in the dissecting room. The first cadaver, which was the 50-yearold, had the normal formation of both anterior jugular veins (AVJ), but down in its course, the left and the AJVs join around the cricoid cartilage and continue down as a single vein running in the mid-line of the neck but ending by piercing deep to drain into the external jugular vein. The second cadaver was 45 years old. After forming the left AJV, the vein immediately crosses over to the right to run parallel to the right AJV before both joining to form a common vein and then piercing to drain in the external jugular vein (EJV). CONCLUSION: The knowledge of these variations has become very important for all health workers dealing with the neck surgically, radiologically or otherwise.

Background Single photon emission computed tomography (SPECT) has been extensively used to evaluate left ventricular (LV) systolic function. However, there are few studies comparing diastolic parameters based on SPECT with established reference values for the assessment of LV diastolic function. Objective To evaluate the sensitivity of SPECT-estimated LV diastolic parameters in coronary heart disease with left ventricular end-diastolic pressure (LVEDP) examined by left cardiac catheterization as the gold standard for comparison. Methods Totally 97 patients with suspected or comfired coronary artery disease were prospectively selected from Department of Cardiology, the Affiliated Hospital of Xuzhou Medical University from September 2021 to January 2022. All of them performed echocardiography, coronary angiography with left cardiac catheterization〔estimating LVEDP, left ventricular end-systolic volume (LVESV) , left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) 〕, SPECT〔estimating LVESV', LVEDV', LVEF', peak filling rate (PFR) , the first third filling fraction (1/3FF) , the first third filling rate (1/3FR) , mean filling rate (MFR) , and peak filling time (TPF) 〕within one to three days of admission. Based on coronary angiography data, all patients had at least one sub-epicardial coronary artery stenosed to over 50%. The general data, laboratory indices, and indices of left heart function were compared between patients with normal LV diastolic function (n=50, LVEDP

ABSTRACT Introduction and objectives: The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) and the Spanish Society of Pediatric Cardiology Working Group on Interventional Cardiology (GTH-SECPCC) introduce their annual activity report for 2020, the starting year of the pandemic of coronavirus disease (COVID-19). Methods: All Spanish centers with cath labs and interventional activity in congenital heart diseases were invited to participate. Data were collected online, and analyzed by an external company together with members from the ACI-SEC and the GTH-SECPCC. Results: A total of 16 centers participated (all of them public) including 30 cath labs experienced in the management of congenital heart diseases, 7 of them (23.3%) dedicated exclusively to pediatric patients. A total of 1046 diagnostic studies, and 1468 interventional cardiac catheterizations were registered. The interventional procedures were considered successful in 93.4% of the cases with rates of major procedural complications and mortality of 2%, and 0.1%, respectively. The most frequent procedures were atrial septal defect closure (377 cases), pulmonary angioplasty (244 cases), and the percutaneous closure of the patent ductus arteriosus (199 cases). Conclusions: This report is the first publication from the Spanish Cardiac Catheterization in Congenital Heart Diseases Registry. The data recorded are conditioned by the COVID-19 pandemic. Diagnostic cardiac catheterization still plays a key role in this field. Most interventional techniques have reported excellent security and efficacy rates.

Objective:Pediatric cardiac catheterization and angiography are two of the methods used in the diagnosis and treatment of patients with congenital heart disease. Anesthesia approaches in these patients are special and come with many anesthetic challenges. In this framework, the objective of this study is to evaluate our anesthesia experience and complications in catheterization procedures performed in the pediatric angiography laboratory.Method:This study was conducted with patients who underwent diagnostic or interventional catheterization in the pediatric angiography laboratory, between August 1st, 2020, and December 31st, 2021. Demographic and clinical characteristics of these patients, including their cardiac diagnosis, gender, weight, procedural characteristics, and anesthesia management principles employed during the procedure and complications, were evaluated.Results:A total of 390 procedures were applied to 360 patients during the period covered by the study. The median age and weight of these patients were three months [interquartile range (IQR) 20 days-7 years)] and 7 kg (IQR 3.4-24), respectively. Of these patients, 51% were male, and 49% were female. Of the 390 procedures, 134 were performed diagnostically, and 256 were performed invasively. The median duration of the procedure was 35 minutes (IQR 25-60). The catheterization procedure was performed under general anesthesia in 33% of the cases. A total of 52 (13.3%) complications were observed during the procedures. During the anesthesia management, hypotension was observed in 17 patients, desaturation in 10 patients, and rhythm disturbances in 7 patients. Two patients needed extracorporeal membrane oxygenation support during the procedure. Four patients had to be operated on urgently. No patient was lost due to the procedure.Conclusion:Anesthesia management is characteristic during the catheterization procedure in pediatric cases with congenital heart disease. A case-specific anesthesia approach should be preferred, taking into account factors such as the type of cardiac pathology, hemodynamic characteristics, and type of procedure.

Abstract The occurrence of hematuria during a right heart catheterization can be a sign of renal perforation, a rare but life‐threatening complication that could be developed due to the misdirection of wire into the abdominopelvic venous plexus. We showed this complication could be managed with venoplasty of the common iliac vein.

Objective: To determine the spectrum of Grown up Congenital Heart (GUCH) at Armed Forces Institute of Cardiology/National Institute of Heart Dieases. Study Design: Descriptive cross sectional study. Place and Duration of Study: Paediatric Cardiac Surgery and Obstetric department of Armed Force Institute of Cardiology/National Institute of Heart Diease, Rawalpindi Pakistan, from 2011 to 2021. Methodology: It was a descriptive cross sectional study conducted at Paediatric Cardiology, Paediatric Cardiac Surgery and Obstetric department of AFIC/NIHD. After taking informed consent, a total of 1344 patients fulfilling inclusion and exclusion criteria with non probability consecutive sampling were enrolled in study from 2011 to 2021. Diagnosis, transthoracic echocardiography findings, procedural details (cardiac catheterization/cardiac surgery/obstetrical intervention) and outcome of all patients were noted. Results: Out of 1344 patients, 700 patients had cardiac catheterization. Among patients who underwent cardiac cath, 304(43%)were males and 396(56.6%) were females. 279(39%) diagnostic and 421(61%) cardiac interventional procedures were done.Most common procedure done was ASD device closure in 227(32%) patients. Complications were seen in 29(4%) patients and mortality in 3(0.4%) patients. There were a total of 188 patients who underwent congenital cardiac surgery. Out of patients who underwent congenital cardiac surgery procedures, 96(51%) were male and 92(49%) were female patients. Major complications were observed in 51(25%) patients and the mortality was 11(5%).There were total of 456 patients in obstetrics department. Out of 456 patients, 54(11%) were with congenital cardiac lesions .The most common defect was VSD 27(6%)patients and dilated cardiomyopathy (DCM) 27(6%) patients followed by ASD and TOF. The maternal and fetal mortality was12(2.7%) and 22(5.5%) respectively. Conclusion:With immense advancement in diagnosis and management of congenital cardiac diseases, a significant number of patients remain undiagnosed and untreated till the time they present as GUCH. Most common presentation is ASD which is mostly manageable by transcatheter intervention, however late presentation carries a risk of complications like pulmonary hypertension.

Objective: To determine the prevalence of brain and neck neoplasms among Interventional Cardiologists. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Department of Cardiology/Interventional Cardiology of two Tertiary Cardiac Care Centers of Rawalpindi and Lahore Pakistan from Mar 2021 to Apr2022. Methodology: By using the non-probability, consecutive sampling technique, fifty Interventional Cardiologists’ (n=50) of both genders between 35-75 years of age, working in the cardiac catheterization labs for more than 10-years are enrolled after their informed consents. The data was collected from the interviews of Interventional cardiologists, from the shared medical records and also from the family members and colleagues. The Interventional cardiologists were enquired about any neurological signs and symptoms particularly in relation to the head and neck malignancy and also asked about undergoing any CT/MRI or PET scan of head and neck region in the past or recent time. Descriptive statistics for data was computed byusing the SPSS version-25. Results: The mean age of the Interventional Cardiologists of tertiary cardiac care center of Rawalpindi was 50.40±7.77years while of Lahore was 49.16±8.89 years. There were 47(94.0%) males and 03(6.0%) females, from both the Institutes. The mean duration of working in cardiac catheterization labs was 17.92±4.57 years. The head and neck neoplasm’s among Interventional Cardiologists was observed in 01(2%) case. Conclusion: The research study concluded that the prevalence of head and neck neoplasms among Interventional Cardiologists is very low (2%). But still it is the need of hour to be more careful about radiation exposure among the Interventional Cardiologists working for long hours in the cardiac catheterization labs, to lessen down the chances of head and neck malignancy.

Anomalous total coronary artery from the pulmonary artery is an extremely rare congenital coronary artery malformation. Only a few cases have been reported over the years, but with no comprehensive medical imaging data. We present the imaging findings of this case with transthoracic echocardiography, trans-esophageal echocardiography, computed tomography angiography (CTA) and cardiac catheterization.

Objective: Cardiac catheterization and angiography can be performed for diagnostic or interventional purposes in patients with congenital heart diseases. This study aimed to evaluate the outcomes of cardiac catheterization in neonates as a newly established unit. Material and Methods: Records of neonates (under 28 days), who underwent cardiac catheterization and angiography procedures in our clinic between October 2020 and July 2021, were retrospectively reviewed. The demographic data of patients, echocardiographic diagnosis, cardiac catheterization, and angiography indications, and their outcomes were evaluated. Results: A total of 76 cardiac catheterization and angiography sessions were performed in 66 neonates (34 males and 32 females), and this number constituted 22% of all angiography procedures performed in our hospital during childhood. Patients' median age and weight were 9 days (range, 1-28) and 3.1 kg (range, 1.7-4.3), respectively. Of the sessions, 88% (67/76) were performed for interventional purposes and 12% (9/76) for diagnostic. In 67 interventional angiography sessions, 74 interventional procedures were performed. The most common interventional procedures were patent ductus arteriosus stenting (n=47/74, 64%); balloon atrial septostomy (n=16/74, 22%); and pulmonary balloon valvuloplasty (n=5/74, 7%). Among the diagnostic procedures, 5 were for postoperative patient evaluation, wherein 3 patients were on extracorporeal membrane oxygenation (ECMO) support. The median procedure and fluoroscopy time were 37 min (range, 9-137) and 468 s (range, 66-2490), respectively. No complications were observed in 64/76 procedures (84%). Hence, complications were observed in 12/76 (16%) procedures, whereas major complications were observed in 8 and minor in 4 procedures. Two patients needed ECMO support in the catheterization laboratory during the procedure. No case died within the first 24 h. One of the two patients, under ECMO, was successfully discharged. Conclusion: With the advancement in technological amenities, cardiac catheterization procedures, especially interventional procedures, could be performed with low mortality and high success rates in newborns. Diagnostic catheterizations should be performed for highlighting the underlying problems after cardiac surgery, where other diagnostic tools are insufficient.

During the COVID-19 pandemic, people voluntarily reduced their necessary healthcare. We examined whether supplying educational digital versatile discs (DVDs) before admission can reduce parental rejection of pediatric cardiac catheterization for congenital heart disease (CHD). Parents of 70 children with CHD selected for cardiac catheterization were randomly allocated to the DVD (received pre-admission DVDs in the outpatient department; 70 parents of 35 children) or non-DVD groups (did not receive the DVDs; 70 parents of 35 children). The parents could reject the admission of their children within 7 days. Cardiac catheterization was rejected by 14 (20.0%) and 26 (37.1%) parents in the DVD and non-DVD groups, respectively (p = 0.025). Parent Perceptions of Uncertainty Scale scores were lower in the DVD (128.3 ± 8.9 points) than in the non-DVD group (134.1 ± 7.3 points; p < 0.001). Decreased uncertainty due to pre-admission DVD watching could have contributed to the increased parental willingness for cardiac catheterization. The effects of pre-admission educational DVDs were more significant among parents with a lower education, rural residence, with only one child, female child, or younger child. Offering educational DVDs to parents of children selected for cardiac catheterization for CHD may decrease the parental rejection rate of the treatment.

Transcatheter closure of patent ductus arteriosus (PDA) for preterm infants is increasingly performed after the Food and Drug Administration approval of the Amplatzer Piccolo Occluder device (Abbott Inc., Abbott Park, IL, USA) in the United States. We report three babies in whom transcatheter closure of PDA was unsuccessful; however, the PDA closed spontaneously in 1–5 days after the transcatheter attempt. The PDA remained closed during follow-up at 3 weeks, 10 weeks, and 17 months, respectively. Mechanical stimulation of the PDA by the wire during attempted device closure likely induced the PDA closure. Further studies are needed to evaluate whether this is a useful alternative therapy in this patient population.

Partial anomalous pulmonary venous return (PAPVR) is a rare congenital condition, and dual-drainage connection PAPVR to the left atrium has been reported in a few cases in the literature; in which cases, percutaneous catheterization was successfully used in lieu of surgery. We, hereby, describe a 7-month-old boy with a functional single-ventricle physiology with dual drainage of the left upper pulmonary vein to the left atrium and the innominate vein. Appropriate recognition of this entity allowed safe occlusion of the anomalous draining vein.

Background and Objective: Coronary disease is the most common life-threatening among chronic diseases. Coronary angiography is one of the most important diagnostic procedures that have complications similar to other invasive procedures. This study was performed to determine the effect of changing sandbag weight on complications of femoral artery catheterization and patient comfort. Methods: This single-blind clinical trial was performed on 140 patients who were referred to Amir Al-Mochr('39')menin Kordkoy hospital in northern Iran. Patients were randomly assigned into four groups consisting 35 patients. After angiography, sandbags with different weights (control group, first intervention, and second intervention, third intervention with weights of 4, 3.5, 3 and 2.3 kg) were placed on the angiography site for 6 hours. Bleeding, hematoma, pain and comfort of patients were recorded and compared immediately, 2, 4, 6, 8 and 24 hours after angiography. Results: Bleeding and hematoma were not observed in any of the patients. There was a significant difference in pain and patients comfort between groups (P

In the normal lung, the only communications between the systemic and pulmonary arterial systems are the connections between the bronchial and pulmonary arteries that occur at the respiratory bronchioles, where pulmonary and bronchial capillaries freely anastomose. Rarely, anomalous connections can occur between normal or aberrant systemic arteries and pulmonary vessels. We performed a comprehensive literature review of all available manuscripts on PubMed and Google Scholar that included a case report or case series with diagnosis of systemic artery to pulmonary venous fistulas who underwent percutaneous treatment. Furthermore, we report three cases of children diagnosed and treated in our Pediatric Cardiology Center.

Objective: To examine the types of procedures and analyze the frequency of anesthesia-related complications during pediatric cardiac catheterization. Study Design: A prospective observational study. Place and Duration of Study: Pediatric Cardiac Catheterization Lab at AFIC/NIHD Rawalpindi, from July 2019 to Nov 2019. Methodology: Total 180 consecutive patients undergoing cardiac catheterization fulfilling inclusion criteria were studied. Demographic variables, diseases, type of procedure, variables and anesthesia-related complications were noted. All the data was analyzed using SPSS-23. Results: The study included180 patients where 96 (53.3%) were male and 84 (46.7%) were female. Most of the patients in our study were between ages 1 to 3 years (85). 99 (55.0%) patients had diagnostic cardiac catheterizetion (CC), while 81 (45%) patients underwent interventional procedures. The overall complication rate noted as 18.9%, including arrhythmia in 11.1% followed by hypotension 4.4%, laryngospasm 3.9% and inotropic support requirement 3.3%, Mortality was 0.6%. Most of the patients presenting to the pediatric cardiac catheterization lab were for PDA device closure (16.6%). Age of child was found to be significant risk factor for cardiac catheterizetion associated complications with a p-value of 0.022. Conclusion: Congenital and structural heart disease catheterization procedures are progressively increasing, especially due to the medical advances and complex interventional therapeutic procedures. A thorough preanesthesia assessment should be carried out to optimize before cardiac catheterization.

Abstract The beating of a pulmonary vein during cardiac catheterization is a rare phenomenon caused by the heart beating through the pericardial effusion when a cardiac tamponade occurs. This “beating pulmonary vein” sign is useful for early detection of a tamponade before circulatory collapse occurs.

Ischemic stroke is a rare and serious complication of coronary angiography and percutaneous coronary intervention, which has high morbidity and mortality. To our knowledge, there is no large-scale randomized controlled trial for the management of catheter-related ischemic stroke. In this case study, we presented a 46-year-old male with peri-procedural ischemic stroke during the coronary angiography (CAG). The CAG was terminated after the stroke and the left carotid artery was selectively cannulated, and digital subtraction angiography (DSA) revealed total occlusion (Modified Thrombolysis in Cerebral Infarction, mTICI, 0) of the M1 part of the left middle cerebral artery (MCA). A stent-assisted thrombectomy was performed and the DSA revealed restoration of flow to the left MCA with mTICI 3 flow in the distal branches. The next day, the neurological exam showed no sensory, motor deficits. The patient was discharged four days later. In the setting of catheter-related stroke, mechanical thrombectomy seems to be the least time-consuming and effective approach.

Abstract Objectives Radial artery occlusion is a silent complication of a transradial approach to cardiac catheterization that may complicate subsequent transradial procedures in patients undergoing cardiac catheterization. A transradial band reduces vascular complications and provides brisk, powerful and effective haemostasis. The purpose of this study was to assess the frequency of radial artery occlusion in 180 patients undergoing transradial coronary catheterization. Results The median age of the study cohort was 58 years. Radial artery occlusion was found in 14 (7.8%) patients. When stratifying by age group and sex, there was no significant difference in radial artery occlusion between age groups and sex. It was likewise found that comorbidities such as diabetes mellitus, hypertension and smoking, increased the risk of radial artery occlusion however this was observed to be significant only for diabetes mellitus. We therefore conclude that a transradial pneumatic pressure band is an extremely helpful and safe strategy to prevent radial artery occlusion.

Background: Sedation and anesthesia are required for procedures in pediatric patients for cardiac catheterization. In this study, we compare anesthetic agents in providing ideal anesthetic conditions with hemodynamic stability. Materials and Methods: A total of 100 patients were randomized into two groups. One group was anesthetized using propofol and ketamine and other group received inhaled sevoflurane (Sevo) as sole anesthetic. Variables were recorded and outcome was compared. Results:Sevo provided faster onset and offset times (P < 0.01), albeit with higher incidence of emergence delirium (P < 0.01) for all other variables both the groups were comparable. Conclusion: Both the groups provided essentially stable and safe anesthetic option for cardiac catheterization for pediatric patients. Sevo provided for faster induction and recovery as compared to IV anesthetics used in the study, but the recovery was complicated in the Sevo group by emergence delirium more frequently. This study failed to record any statistically significant hemodynamic variation between the two groups.

Objective: To compare the incidence along with risk factors of vascular complications between patients having undergone Coronary angiography/Percutaneous Coronary Interventions (CAG/PCIs); as day cases and those as inpatients. Material and Methods: Our study is a retrospective cohort study. We performed a retrospective chart review of the patients, visiting a heart center of the hospital from October, 2014 to September, 2018. We included patients of a minimum 18 years of age, who had undergone CAG/PCIs. Excluded patients were those who had been referred from other hospitals. The main outcomes were vascular complications defined as: (1) bleeding with significant blood loss during the procedure. (2) Hematoma within 1 month after the procedure. Wilcoxon’s rank sum and chi-squared test were used to assess the risk factors. Results: Of all 784 patients having undergone CAG/PCI, 387 were day cases and 397 were inpatients. Only 12 cases developed vascular complications. The incidence of vascular complications was not significantly different between either day case; whose incidence was 1.3% (95% confidence interval (CI), 0.72-1.87), and inpatients; whose incidence was 1.8% (95% CI, 1.10-2.42). We found that the risk factors of vascular complications were percutaneous coronary intervention, and using a vascular closure device to remove the introducer sheath. Conclusion: Performing CAG/PCI as day cases did not increase the risks of complications post-procedure, as compare to the inpatients. However, due to the small numbers of patients with complications future studies with more patients are needed to ensure the safety of day case CAG/PCI. Patients undergoing PCI, or patients with vascular closure devices used should be closely observed before discharge.

Background The femoral approach has been preferably used to access in interventional cardiology, being perceived as easy and facilitating quick access with relatively low risk. In the hands of experienced operators and high-volume centers, the radial approach offers improved patient comfort, decreased access-site complications, and decreased costs without compromising procedural success on long-term outcomes. Patients presenting with ST-elevation myocardial infarction, in particular, benefit from a transradial approach to coronary intervention. Owing to the results of the latest studies, the radial approach has become increasingly popular. Radial access is known to have a steep learning curve. The effect of this results in the hesitation of performing percutaneous coronary intervention through radial route by conventional femoral access operators. A growing body of evidence supports the adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this study was to propose and support a transradial strategy for patients with stable coronary artery disease as well as those presenting with acute coronary syndromes. The aim of this study was a safety analysis of coronary interventional procedures according to the access vessel. Materials and methods A total of 204 coronary interventions done in the Department of Interventional Cardiology were retrospectively analyzed. All the procedures were classified according to femoral or radial access. The incidence of local complications (e.g. major bleedings and hematomas) was assessed as well as the volume of contrast agent administered during the procedure and the fluoroscopy time of the procedure. Results It has been shown that radial approach, which is obviously more comfortable for patients, reduces the risk of local complications (0 vs 2.97% and 0 vs 3.96%). However, there could be a larger volume of contrast agent administered (P=0.029), which in some cases could increase the risk of contrast-induced nephropathy, and redial access has a longer fluoroscopy time. Conclusion The radial approach should be recommended as a first choice because it is safer than the classical femoral approach because it is associated with a lower incidence of complications, but one must be cautious in choosing radial-approach patients with renal insufficiency, especial in early learning because of the use of high contrast volume.

ABSTRACT Objective To examine the accuracy of a pulmonary hypertension screening strategy based on a combination of echocardiographic data and tomographic measurements (pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio) in patients with chronic lung disease referred for lung transplantation. Methods A retrospective observational study with patients with pulmonary emphysema or fibrosis referred for transplantation between 2012 and 2016. Pulmonary hypertension was defined as mean pulmonary artery pressure ≥25mmHg, or between 21 and 24mmHg, with pulmonary vascular resistance >3 Wood units on right heart catheterization. Tomographic measurements were made by two independent radiologists. Results This sample comprised 13 patients with emphysema and 19 patients with pulmonary fibrosis. Of these, 18 had pulmonary hypertension. The level of agreement in tomographic measurements made by radiologists was high (intraclass correlation coefficients 0.936 and 0.940, for pulmonary artery diameter and pulmonary artery diameter to ascending aorta diameter ratio, respectively). Areas under the ROC curves constructed for pulmonary artery diameter, pulmonary artery diameter to ascending aorta diameter ratio, and pulmonary artery systolic pressure as predictors of pulmonary hypertension were 0.540, 0.629 and 0.783, respectively. The sensitivity, specificity and negative predictive value of pulmonary artery systolic pressure ≥40mmHg were 67%, 79% and 65%, respectively. The combined criterion (pulmonary artery diameter to ascending aorta diameter ratio >1 and/or pulmonary artery systolic pressure ≥40mmHg) achieved sensitivity of 72%, specificity of 79%, and a negative predictive value of 69%. Conclusion Measurements of pulmonary artery and ascending aorta diameter were highly reproducible. The association of pulmonary artery and aortic diameter >1 and/or pulmonary artery systolic pressure ≥40mmHg improved the sensitivity and the negative predictive value for pulmonary hypertension screening. This strategy demands prospective validation to assess safety and cost-effectiveness.

ABSTRACT Introduction and objectives: Today it has become increasingly common to perform procedures without withdrawing oral anticoagulation. However, the need to withdraw oral anticoagulants prior to cardiac catheterization in patients chronically anticoagulated (OACs) remains controversial. We evaluated the efficacy and safety of performing transradial catheterization in outpatients without withdrawing direct-action oral anticoagulants (DOACs). Methods: Prospective and observational study where 270 patients who underwent elective transradial cardiac catheterization were included from January 2013 through November 2017, divided into 3 groups of 90 patients based on their anticoagulant intake: group A (without OAC), with group B (with vitamin K antagonist), and group C (with DOACs), and matched according to the date of completion. In no case was the OAC discontinued before the procedure. We evaluated the complications of radial access within the first 24 h and 1 month after the procedure. Results: The group of patients on DOACs had a higher proportion of men compared to the vitamin K antagonist group (71.1% vs 47.8%; P = .01) and patients were younger in the group without OAC (63.45 ± 11.47 vs 70.22 ± 9.35; P = .03). Group B had a lower percentage of diabetic patients (22.2% vs 36.67% in group C, P = .03). In group A, patients were more prone to having a history of ischemic heart disease compared to the groups of anticoagulated patients (27.84% vs 14.44% in group C, P = .028) in addition to a more frequent intake of antiplatelet drugs. Radial access was the access of choice in most patients (98.2%). There were no significant differences when it comes to vascular access complications among the groups being the rate of hematoma and/or bleeding at discharge equal to 1.1% in the DOACs group and the arterial occlusion rates both at discharge and at 1 month between 0% and 2.2%. Conclusions: In our experience performing transradial diagnostic cardiac catheterizations without discontinuation of DOACs is safe, with low rates of thrombotic and hemorrhagic complications, without any differences with vitamin K antagonist and no OAC.

Pulmonary hypertension is a frequent and severe complication of systemic sclerosis (SSc). SSc-PAH patients have a worse prognosis than patients with idiopathic PAH. We report a case of a patient with delayed SSc and PAH diagnostics. Limited SSc was established in a 61-year-woman with 20 years of Raynaud’s syndrome anamnesis. But diagnosis of SSc-PAH was determined in severe and late symptomatic stage with signs of right heart congestion, NYHA III FC and mPAP 48 mmHg. This emphasizes the need for clinicians to be aware of limited SSc and have a high index of PH suspicion in such patients.

Coronary artery fistulas (CAFs) are rare abnormal communications between a normal coronary artery and a cardiac chamber or great vessel, such as the pulmonary artery, bypassing the myocardial capillary network. We report the case of a 17-year-old male with a medical history of pulmonary valve stenosis, who presented with progressive dyspnea and fatigue. Transthoracic Doppler echocardiography showed multiple continuous flows both on the apical interventricular septum and entering the left atrium. A tortuous CAF arising from the left main coronary artery to the left atrium was revealed by coronary angiography. The lesion was successfully closed percutaneously using an off-label Amplatzer™ Duct Occluder II Additional Sizes with a backup support of a modified “mother–child” system. This case highlights the effort of both pediatric and adult cardiology teams to come up with new potential strategies and combined techniques to overcome the difficulties of managing complicated CAFs, such as the use of percutaneous coronary intervention techniques and the selection of the most adequate occlusion devices, even when used off-label.

Aims. Here, we report a case of very late (70+ days) development of pseudoaneurysm on the site of sheath insertion in a 60- year old woman. Methods. The patient underwent cardiac catheterization using transradial approach. Results. Despite the transradial approach, which is generally considered as a suitable prevention of this problem, and despite absence of any periprocedural complications, the patient developed a pseudoaneurysm after more than 70 days from the procedure. Conclusions. In some cases, a pseudoaneurysm may develop extremely late after cardiac catheterization. Such an extremely late development of pseudoaneurysm has not been described in literature so far.

Objective: Diagnostic and interventional cardiac catheterization procedures for congenital heart diseases (CHD) are becoming increasingly more popular, and arrhythmia is a well-known complication. This study was an evaluation of the incidence and causative agents of arrhythmia and the subsequent treatment strategies applied during cardiac catheterization. Methods: The catheterization data of all of the patients who underwent diagnostic cardiac catheterization for CHD between January 2012 and 2018 at a single center were examined retrospectively. Results: A total of 1316 children underwent diagnostic cardiac catheterization due to CHD. The median age and body weight was 18 months (6 days-21 years) and 9.9 kg (2.2–135 kg), respectively. Patients with ventricular septal defect (281 patients) and those with tetralogy of Fallot (257 patients) represented 2 major groups in the study population. In 93 (7%) patients, arrhythmia developed during cardiac catheterization. Among them, there were 58 (62%) cases of bradyarrhythmia and 35 (38%) cases of tachyarrhythmia. Arrhythmia was classified as low, high, or major, according to the adverse event severity score; the rates were 2.7%, 4.3%, and 1.2%, respectively. In 36 (39%) patients, there was no need for therapy, whereas 57 (61%) required treatment to eliminate the arrhythmia. Treatment modalities included catheter manipulation in 15, pharmacological therapy in 24, and cardioversion in 3 patients. Eleven patients required cardiopulmonary resuscitation. Temporary pacemaker implantation was required in 2 patients, while 2 others underwent permanent pacemaker implantation secondary to catheterization-related arrhythmia. There were no cases of mortality secondary to catheterization-related arrhythmia. Conclusion: Diagnostic cardiac catheterization in CHD may result in various types of cardiac arrhythmias. The proper management of arrhythmias may reduce morbidity and mortality related to cardiac catheterization.

X-ray fluoroscopy-guided endovascular procedures have several significant limitations, including difficult catheter navigation and use of ionizing radiation, which can potentially be overcome using a magnetically steerable catheter under MR guidance. The main goal of this work is to develop a microcatheter whose tip can be remotely controlled using the magnetic field of the MR scanner. This protocol aims to describe the procedures for applying current to the microcoil-tipped microcatheter to produce consistent and controllable deflections. A microcoil was fabricated using laser lathe lithography onto a polyimide-tipped endovascular catheter. In vitro testing was performed in a waterbath and vessel phantom under the guidance of a 1.5-T MR system using steady-state free precession (SSFP) sequencing. Various amounts of current were applied to the coils of the microcatheter to produce measureable tip deflections and navigate in vascular phantoms. The development of this device provides a platform for future testing and opportunity to revolutionize the endovascular interventional MRI environment.

Objective: To evaluate the incidence of contrast-induced nephropathy (CIN) and its contributing factors after cardiac catheterization in type II diabetic patients. Study Design: Cross sectional study. Place and Duration of Study: Choudhary Pervaiz Ellahi Institute of Cardiology (CPEIC), Multan for six months, from Aug 2016 to Mar 2017. Material and Methods: This cross sectional study was conducted and completed in the department of cardiology Choudhary Pervaiz Ellahi Institute of Cardiology (CPEIC), Multan for six months (August 2016 to March 2017). Before start of the study ethical approval was obtained from hospital ethical board/committee; informed consent was taken from patients and their attendants after complete information and they were also ensured about their confidentiality. All collected data was aligned and entered in a computer software SPSS version 23.1 and data was analyzed. Mean ± SD values were calculated and presented for quantitative data variables like age, similarly frequency (percentages) were calculated and presented for qualitative variable data like gender. After stratification of data, student chi square test was used to see effect modification. A p-value ≤0.05 was considered as significant. Results: A total number of 255 patients were included in the study. All patients were admitted for cardiac catheterization. Participants of the study were divided into two groups on the basis of CIN presence. Group A consisted of 210 patients who didn’t develop contrast-induced nephropathy (CIN) after catheterization of coronary artery. Group B consisted of 45 patients of CIN after catheterization of coronary artery. It was found that incidence of CIN in diabetic patients with micro-albuminuria was 17.64% (n=45). Conclusion: Observation of our study found that diabetic patients either with normal baseline creatinine are at an increased risk of developing CIN after angiography of coronary artery.