Interventional cardiac catheterization procedures in pediatric cardiac transplant patients: transplant surgery is not the end of the road.
OBJECTIVE
The objectives of this study are to report the spectrum of cardiac lesions in pediatric patients post-orthotopic heart transplantation (OHT), the characteristics of patients who develop these lesions, and the feasibility of transcatheter intervention in treating these lesions.


BACKGROUND
Indications for OHT in the pediatric population range from cardiomyopathy to complex congenital heart defects with and without prior palliation. These patients may have residual vascular access and great vessel abnormalities.


METHODS
Data was collected through retrospective review of all OHT patients at our institution from 1988 to 2005.


RESULTS
During the study period, 276 heart transplants were performed. Forty-seven patients, age 1.6 [0.1-26] years with a weight of 9.5 [3.5-96.0] kilograms, underwent 69 procedures. Patients with original diagnoses of hypoplastic left heart syndrome and failed palliations required intervention most frequently. Sixteen patients, all with a history of left sided disease, developed aortic arch obstruction. Fifteen were successfully treated with balloon angioplasty while one has recurrent supravalve aortic obstruction. Fourteen patients had superior vena cava obstruction treated with balloon angioplasty and/or stent placement. Twelve patients required no further intervention and two required further stent placement. Ilio-femoral vein occlusion was treated with balloon angioplasty alone in 4 patients and stent placement in 10 patients to achieve vessel patency. Other procedures included treatment of branch pulmonary artery and pulmonary vein stenosis.


CONCLUSIONS
Anastomotic aortic arch and venous obstructive lesions should be sought following pediatric OHT as they occur in almost 20% of patients and can be successfully addressed using interventional techniques.
Morchi
Gira S
GS
Department of Pediatric Cardiology, The Children's Hospital/University of Colorado Health Sciences Center, Denver, Colorado, USA.
Pietra
Biagio
B
Boucek
Mark M
MM
Chan
Kak-Chen
KC
D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon / Q000295:instrumentation; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D001018:Aortic Diseases / Q000209:etiology / Q000628:therapy; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000628:therapy; D006328:Cardiac Catheterization; D009202:Cardiomyopathies / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010166:Palliative Care; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013479:Superior Vena Cava Syndrome / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000628:therapy; D055815:Young Adult