The country’s cardiology centers have been producing subspecialists in the field of Invasive and Interventional Cardiology. To date, 11 hospitals and/or medical centers are involved in training these subspecialists in a 1 to 2-year program. And to this date, there have been no uniform standards and guidelines as to what comprises the basic and/or acceptable training outcomes for the interventionalist in training. This paper describes the development of the core curriculum for an interventional cardiovascular training program to prepare its trainees to be competent in performing invasive diagnostic and interventional cardiovascular procedures as part of comprehensive patient care. The task force for the core curriculum of the interventional training program gathered several officers and leaders of the PSCCI, the training heads of the various interventional programs in the country, as well as experts in the field of cardiology education. Through a series of meetings, consultations, and workshops, the task force laid out the template on which all the training programs would be based. Such a framework considered the international standards regarding minimum caseloads for interventional training and the peculiar situation of each training institution. International standards like the Core Cardiovascular Training Statement (COCATS 4) Task Force 10: Training in Cardiac Catheterizations and the 2020 EAPCI Core Curriculum for Percutaneous Cardiovascular Interventions served as the reference framework for key recommendations. A consensus was achieved that upheld the highest standards of competence without disenfranchising certain institutions due to intricacies and uniqueness of hospital set-up and training situation.

Training ; Education ; Curriculum

INTRODUCTION

TStenting of the ductus is an alternative to surgical shunt in patients with critical pulmonary stenosis who remain ductal dependent following valvuloplasty. Stents close spontaneously after improvement of right ventricular function; however, in rare cases, stents fail to completely endothelialize, resulting in pulmonary overcirculation.

CASE PRESENTATION

The first case was a 3-year-old who had critical pulmonary stenosis at birth, and the second case was a 3-year-old boy who at 5 months of age was managed for severe pulmonary valve stenosis. Both underwent stenting of the duct and percutaneous pulmonary balloon valvuloplasty. On follow-up, the patent ductus arteriosus (PDA) stent of both cases remained patent even after an adequate growth and improvement of the right ventricle, resulting in significant left-to-right shunting and development of increased pulmonary blood flow; hence, percutaneous transcatheter closure of the stented PDA was done.

DISCUSSION

Stenting of the ductus allows significant and balanced growth of the pulmonary artery in patients with duct-dependent congenital heart diseases leading to adequate growth of the right ventricle. Persistence of patency of stent causing significant left-to-right shunting warrants closure of the PDA stent. Closure of the stent is challenging and requires a high degree of technical skill because of the difficulty to enter the partially closed stent.

CONCLUSION

Percutaneous transcatheter closure of a stented PDA in patients with critical pulmonary stenosis can be a technically challenging procedure because of the difficulty to enter the stent due to the presence of intrastent endothelial proliferation.

Heart Defects, Congenital ; Ductus Arteriosus, Patent ; Stents

INTRODUCTION

Ductal stenting can be a nonsurgical option and less morbid method to provide pressure and volume overload to the regressing left ventricle in late presenters of transposition of the great arteries, intact ventricular septum (TGA-IVS), prior to arterial switch operation (ASO).

CASE PRESENTATION

This is a case of an infant diagnosed with TGA-IVS beyond the neonatal period who underwent balloon atrial septostomy and ductal stenting to retrain involuted left ventricle prior to definitive ASO.

DISCUSSION

Ductal stenting is an alternative option in late presenters of transposition of the great arteries with involuted left ventricle. It provides volume loading and, to a lesser extent, pressure loading leading to left ventricular hypertrophy. Also, presence of the stented duct allows improved oxygenation eliminating the need for aortopulmonary shunt. It can be a less morbid method of left ventricular training because it avoids hemodynamic stress, pulmonary artery distortion, and neoaortic valve regurgitation.

CONCLUSION

Ductal stenting in late presenters with TGA-IVS successfully retrains the left ventricle and achieves safe late ASO.

Heart Defects, Congenital ; Transposition of Great Vessels ; Arterial Switch Operation