During the last 10 years, there have been major technological achievements in pediatric interventional cardiology. In addition, there have been several advances in cardiac imaging, especially in 3-dimensional imaging of echocardiography, computed tomography, magnetic resonance imaging, and cineangiography. Therefore, more types of congenital heart diseases can be treated in the cardiac catheter laboratory today than ever before. Furthermore, lesions previously considered resistant to interventional therapies can now be managed with high success rates. The hybrid approach has enabled the overcoming of limitations inherent to percutaneous access, expanding the application of endovascular therapies as adjunct to surgical interventions to improve patient outcomes and minimize invasiveness. Percutaneous pulmonary valve implantation has become a successful alternative therapy. However, most of the current recommendations about pediatric cardiac interventions (including class I recommendations) refer to off-label use of devices, because it is difficult to study the safety and efficacy of catheterization and transcatheter therapy in pediatric cardiac patients. This difficulty arises from the challenge of identifying a control population and the relatively small number of pediatric patients with congenital heart disease. Nevertheless, the pediatric interventional cardiology community has continued to develop less invasive solutions for congenital heart defects to minimize the need for open heart surgery and optimize overall outcomes. In this review, various interventional procedures in patients with congenital heart disease are explored.
Cardiac Catheters ; Cardiology* ; Catheterization ; Catheters ; Cineangiography ; Echocardiography ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Magnetic Resonance Imaging ; Off-Label Use ; Pulmonary Valve ; Thoracic Surgery

BACKGROUND: Evaluation of left ventricular (LV) size and function is one of the important reasons for performing echocardiography. Real time three dimensional echocardiography (RT3DE) is now available for a precise non-invasive ventricular volumetry. Aim of work was to validate RT3DE as a non-invasive cardiac imaging method for measurement of LV volumes using cardiac angiography as the reference technique. METHODS: Prospective study on 40 consecutive patients with tetralogy of Fallot (TOF) referred for cardiac catheterization for preoperative assessment. Biplane cineangiography, conventional 2 dimensional echocardiography (2DE) and RT3DE were performed for the patients. A control group of 18 age and sex matched children was included and 2DE and RT3DE were performed for them. RESULTS: The mean LV end diastolic volume (LVEDV) and LVEDV index (LVEDVI) measured by RT3DE of patients were lower than controls (p value = 0.004, 0.01, respectively). There was strong correlation between the mean value of the LVEDV and the LVEDVI measured by RT3DE and angiography (r = 0.97, p < 0.001). The mean value of LV ejection fraction measured by RT3DE was lower than that assessed by 2DE (50 ± 6.2%, 65 ± 4.6%, respectively, p value < 0.001) in the studied TOF cases. There was good intra- and inter-observer reliability for all measurements. CONCLUSION: RT3DE is a noninvasive and feasible tool for measurement of LV volumes that strongly correlates with LV volumetry done by angiography in very young infants and children, and further studies needed.
Angiocardiography* ; Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Child* ; Cineangiography ; Echocardiography ; Echocardiography, Three-Dimensional* ; Humans ; Infant ; Methods ; Prospective Studies ; Tetralogy of Fallot*

BACKGROUND AND OBJECTIVES: Coronary angiography (CAG) is the gold standard for diagnosing coronary artery disease. However, exposure to ionizing radiation delivered during CAG has various negative biological effects on humans. In this study, there was an evaluation of whether fluorography resulted in decreased radiation exposure, as compared with cineangiography. SUBJECTS AND METHODS: Fifty-five patients were prospectively enrolled and divided into two CAG groups, in accordance with the operator's professional discretion: a conventional cineangiography group versus a fluorography group. Fluorography refers to the photography of fluoroscopic images that are retrospectively stored, e.g., using the "Store fluoro" function of the Siemens cardiac angiography system. The primary outcomes included the air kinetic energy released per unit mass {air kerma (AK) mGy} and the dose (kerma)-area product (DAP; microGy . m2), both measured using built-in software in the Siemens system. The secondary outcomes included the total procedure time and amount of contrast agent used with each CAG method. RESULTS: The total AK and DAP were significantly lower in the fluorography group (159.3+/-64.9 mGy and 1337.9+/-629.6 microGy . m2, respectively) than in the cineangiography group (326.9+/-107.5 mGy and 2341.1+/-849.9 microGy . m2, respectively; p=0.000 for both). The total procedure time (cineangiography vs. fluorography, 12.8+/-4.7 vs. 12.5+/-2.9 min; p=0.779) and contrast agent amount (136.1+/-28.3 vs. 126.3+/-25.7, p=0.214) were comparable between the two groups. CONCLUSION: Fluorography is a useful method to decrease the radiation exposure in selected patients requiring CAG.
Angiography ; Cineangiography* ; Coronary Angiography* ; Coronary Artery Disease ; Fluoroscopy ; Humans ; Photography ; Prospective Studies ; Radiation, Ionizing ; Retrospective Studies

PURPOSE: To analyze the cineangiographic appearance and determine the clinical importance of coronary-to-bronchial artery communication. MATERIALS AND METHODS: The coronary cineangiograms of 4,620 patients were reviewed, and 12 cases of coronary-to-bronchial artery communications were observed in 10 patients (M:F=6:4; mean age, 48.4 years). The cineangiographic findings were analyzed and correlated with these of other imaging studies [perfusion scan (n=5), computed tomographic angiography (CTA) (n=4), conventional chest computed tomography (CT) (n=1), and conventional angiography (n=6)]. RESULT: Cineangiography revealed that hypertrophied branches of the coronary artery communicated with bronchial arteries in which adjacent hypervascular staining, was observed, and which were accompanied by pulmonary shunts (n=9). The underlying diseases identified among the ten patients were Takayasu arteritis (n=5), chronic inflammatory pulmonary disease (n=3), pulmonary thromboembolism (n=1), and or newly diagnosed pulmonary tuberculosis (n=1). The lung fields supplied by coronary-to-bronchial communication showed close correlation with the territories of perfusion defects, decreased pulmonary vascularity, or inflammatory lesions revealed by other imaging studies. CONCLUSION: Coronary-to-bronchial artery communication can present as a secondary result of occlusive disease of the pulmonary arteries or chronic pulmonary inflammation, and in patients with hemoptysis involving, for example, incomplete embolization or myocardiac infarction, it may be problematic.
Angiography ; Arteries ; Bronchial Arteries* ; Cineangiography ; Coronary Vessels ; Hemoptysis ; Humans ; Infarction ; Lung ; Lung Diseases ; Perfusion ; Pneumonia ; Pulmonary Artery ; Pulmonary Embolism ; Takayasu Arteritis ; Thorax ; Tuberculosis, Pulmonary

BACKGROUND AND METHOD: For decades, the presence of aortic insufficiency (AI) has been considered a potential hazard in military aviation and has generally excluded aircrew from high performance flight. The cardiovascular effect of repeated exposure of high +Gz forces associated with AI is largely unknown. To evaluate whether the flying of High Performance Aircraft (HPA) was detrimental to subjects with AI, we performed a retrospective review. we studied 32 asymptomatic patients in whom 16 of them had flying time with AI in HPA(Group I), others(GroupII, Control Gr.) in Low-G Aircraft(LGA). Among them, the data of 24 patients were available, 12 in group I., and 12 in group II. The two groups were matched for age, severity of AI, and flying time. RESULTS: Interval echocardiographic, and cineangiographic studies were obtained over a mean period of 4.6+/-2.6 years in group I and 5.9+/-4.2 years in group II (range, 0.9 to 12.7 years) and mean flying time with AI of 528.1+/-435.0 hours in group I and 865.0+/-816.1 hours in group II (range, 50 to 2290 hours). By paired-t test, there were no significant differences between both groups in left ventricular end-diastolic dimension (LVEDD), end-systolic dimension (LVESD), aortic dimension (Ao.D) and fractional shortening (FS) by echocardiography (p>0.05) and by multiple linear regression, there were no significant interval changes of above values in Gr. I according to increasing of flying time with AI (p>0.05). Visual grade by doppler echocardiography or aortic cineangiography increased 1 patient in Gr.I and 2 patients in Gr.II within no more than one grade. CONCLUSION: Thus, this study demonstrated that : 1) Quantitative echocardiographic measurements such as LEVDD, LVESD, Ao.D and FS didn't show significant interval change in Gr.I.2) A single subject with a minor increase in AI severity together with no difference between the HPA and LPA groups argue for a relatively chronic effect of high G exposure in aircrew with mild AI.
Aircraft ; Aviation ; Cineangiography ; Diptera* ; Echocardiography* ; Echocardiography, Doppler ; Humans ; Linear Models ; Military Personnel ; Retrospective Studies

A pulmonary artery catheter (PAC) is a useful monitoring device for measuring pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac output, but its insertion brings about many complications including pulmonary artery rupture, infarction, thrombosis and infection. This case concerns the knotting of a PAC in a 27 year-old female patient who had undergone cardiac transplantation due to dilated cardiomyopathy. The PAC was inserted via the right subclavian vein to the pulmonary artery and withdrawn to the superior vena cava before heart was removed. After the weaning of the cardiopulmonary bypass (CPB), we tried to reinsert the PAC, which was neither advanced nor withdrawn. Postoperative chest x-ray revealed that the PAC appeared to be knotted in the subclavian vein. Two days later, we loosened the knot of the PAC and removed it via femoral and bracheal cineangiography techniques guided by fluoroscopy without any complications. In this case, we thought the knotting of the PAC occurred at insertion due to severe tricuspid regurgitation, and its size was reduced at withdrawal before the CPB and wedging to the subclavian vein. Knotting of PAC is very rare and unpredictable, but once it or other complications of the PAC is suspected, we recommend that the manipulation of the PAC should be stopped and x-ray should be checked.
Adult ; Cardiac Output ; Cardiomyopathy, Dilated ; Cardiopulmonary Bypass ; Catheters* ; Cineangiography ; Female ; Fluoroscopy ; Heart ; Heart Transplantation* ; Humans ; Infarction ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Rupture ; Subclavian Vein ; Thorax ; Thrombosis ; Tricuspid Valve Insufficiency ; Vena Cava, Superior ; Weaning

We performed a reoperation of failed tricuspid mechanical valve in a 63-year-old female patient because the overgrown endothelial pannus had entrapped the prosthetic leaflets. Four years ago, the patient underwent mitral and tricuspid valve replacements with 31 and 33 mm Carbomedics, respectively. The patient showed symptoms of neck vein distention, abdominal distention and peripheral edema. The chest film, echocardiography and cineangiography confirmed the diagnosis of tricuspid valve. During the operation, we found the entrapped leaflets of the tricuspid valve in a partially closed state and the endothelial pannus had overgrown into the leaflets. Carpentier-Edward bovine pericardial valve was inserted and the patient was discharged with no significant events.
Cineangiography ; Diagnosis ; Echocardiography ; Edema ; Female ; Humans ; Middle Aged ; Neck ; Reoperation* ; Thorax ; Tricuspid Valve ; Veins

Pulmonary artery sling is a rare and potentially lethal vascular anomaly wherein the anomalous left pulmonary artery arises from the posterior aspect of the right pulmonary artery and passing to the left lung between the trachea and the esophagus which causes respiratory distress in infants and children due to the extrinsic compression of the airway by the anomalous vessel. Associated anomalies are common, particularly those of the tracheobronchial tree. The most common lesions are hypoplasia of the distal trachea and right main stem bronchus. About 50 percent of patients have cardiovascular anomalies, such as in the left superior vena cava, atrial septal defect, ventricular septal defect, patent ductus arteriosus, aortic arch anomalies, tetralogy of Fallot 1 etc. We experienced a case of a 6-year-old boy who showed dyspnea and frequent pneumonia. He was diagnosed with pulmonary artery sling associated with left bronchial stenosis, patent ductus arteriosus, and left superior vena cava which was parven by echocardiographic examinations, spiral computerized tomography of the chest and cineangiography. We report this case with related literature.
Aorta, Thoracic ; Bronchi ; Child ; Cineangiography ; Constriction, Pathologic* ; Ductus Arteriosus, Patent* ; Dyspnea ; Echocardiography ; Esophagus ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Infant ; Lung ; Male ; Pneumonia ; Pulmonary Artery* ; Tetralogy of Fallot ; Thorax ; Tomography, Spiral Computed ; Trachea ; Vena Cava, Superior

OBJECTIVE: Left ventricular ejection fraction is an important clinical variable with respect to diagnosis, treatment and prognosis in various cardiovascular diseases. Measurement of left ventricular ejection fraction is performed by three commonly used methods, M-mode and two dimensional echocardiography, radionuclide angiography and contrast cineangiography. We compared echocardiographic and contrast cinean-giographic ejection fraction by correlation coefficiency to determine the accuracy of echocardiography determined ejection fraction at our institution and to assess the agreement of left ventricular ejection fraction between two methods. METHODS: We measured left ventricular ejection fraction by M-mode, two-dimensional echocardiography and contrast cineangiography in 144 cases of normal and cardiovascular heart disease patients from September 1993 to April 1995 in the cardiology division of Ewha Womans University hospital. The echocar-diography and contraat cineangiography were performed within 7 days of each other. RESULTS: M-mode echocardiographic ejection fraction correlated with contrast cineangiographic ejection fraction (r=0.7841). M-mode echocardiographic ejection fraction corrected with two-dimensional echocardiography in the presence of regional wall motion abnormality correlated with contrast cineangiographic ejection fraction (r=0.8149). By agreement analysis, the difference of mean of ejection fraction measured by M-mode echocardiography and contrast cineangiography was within 95% confidence limits. The mean was 4.08% and the standard deviation was 8.29%. The difference of mean of ejection fraction corrected by two-dimensional echocardiography and contrast cineangiography was within 95% confidence limits. The mean was -3.19% and the standard deviation was 7.74% CONCLUSION: The values of left ventricular ejection fraction by echocardiography showed good correlation with those of contrast cineangiographic ejection fraction, Therefore, echocardiography would be a useful tool as contrast cineangiography in evaluating the left ventricular function.
Cardiology ; Cardiovascular Diseases ; Cineangiography* ; Diagnosis ; Echocardiography* ; Female ; Heart Diseases ; Humans ; Prognosis ; Radionuclide Angiography ; Stroke Volume* ; Ventricular Function, Left

BACKGROUND: The clacification of the wall and narrowing of the lumen of the coronary artery is closely related to the process of atherosclerosis and its severity. Thus, the present study of calcified coronary artery lesions by analysis of cineangiography is attempt to define the incidence and factors to affect the coronary artery calcification. METHODS: Our report concerns a consecutive series of 513 patients who underwent coronary angiography between January 1, 1991 and September 30, 1993. We determined the relationship between the coronary artery calcification and sex, age, risk factors, serum calcium, BUN, creatinine, lesional lumen stenosis and severity of coronary artery disease. RESULTS: Among patients with significant coronary artery disease, 22%(62/282 cases) had the coronary artery calcification by cineangiography. Patients with calcification were older(62+/-8 years) than those without calcification(56+/-10 years)(p=0.0001). The distribution of calcified coronary artery was 35 lesions in LAD, 17 in LCX, 16 in RCA and 4 in LM. The calcification rate was 38%(40/104 cases) for patients with multi-vessel disease, compared to 12%(22/178 case) for those with single vessel disease(p=0.0001). Patients with calcification significantly had the long lesion(22.4+/-13.4mm), compared to those without calcification(18.0+/-11.3mm)(=0.012). Coronary artery calcification was correlated with smoking habits. CONCLUSION: Coronary artery calcification was seen in 22 percent and strongly correlated with age, smoking habits, the severity of disease and length of lesion.
Atherosclerosis ; Calcium ; Cineangiography* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Creatinine ; Humans ; Incidence* ; Risk Factors ; Smoke ; Smoking