title: The First Ten of Everything: A Review of Past and Current Practice in Pediatric Cardiac Percutaneous Interventions.
abstract: OBJECTIVE
  This study was designed to compare outcomes of the most common pediatric cardiac interventions from the time of implementation with the current era.
  
  
  BACKGROUND
  Since the introduction of semilunar valve balloon dilation and device closure of the arterial duct and septal defects, development of interventional techniques and devices has been rapid. However, few studies have compared outcomes between those initial interventions and those in the current era.
  
  
  METHODS
  Five validated common catheter-based therapies were chosen for analysis, including atrial and duct device closure, balloon dilation of the aortic and pulmonary valves, and native coarctation of the aorta. A retrospective review of the first and most recent 10 consecutive patients in each group was performed.
  
  
  RESULTS
  There was a high mortality (30%) among neonates who underwent aortic valve (AV) dilation in the early era, but no mortality noted in other groups. In the early era, transcatheter atrial defect closure and AV dilations were associated with a low success rate (60% for both lesions) and a high complication rate (40% for atrial septal defect, 30% for AV dilations). Among the last 10 children, the atrial defect occlusion was successful in 100% without complications and AV dilations where successful in all children with a 30% complication rate (one major, two minor).
  
  
  CONCLUSIONS
  A learning curve with device development plays a significant role in the evolution of transcatheter techniques. These data provide baseline estimates of success and may be used as a template in the future when new techniques are adapted into practice.
authors.affiliation: The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Otto P
authors.initials: OP
authors.lastname: Rahkonen
authors.affiliation: The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Rajiv C
authors.initials: RC
authors.lastname: Chaturvedi
authors.affiliation: The Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Centre, The Cardiac Diagnostic and Interventional Unit, The Hospital for Sick Children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
authors.forename: Lee N
authors.initials: LN
authors.lastname: Benson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000266:history / Q000295:instrumentation / Q000401:mortality / Q000639:trends; D002309:Cardiology / Q000266:history / Q000639:trends; D002648:Child; D002675:Child, Preschool; D004059:Diffusion of Innovation; D018572:Disease-Free Survival; D006330:Heart Defects, Congenital / Q000266:history / Q000401:mortality / Q000628:therapy*; D049673:History, 20th Century; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D009864:Ontario; D010372:Pediatrics / Q000266:history / Q000639:trends; D000069079:Radiation Exposure; D015641:Radiography, Interventional / Q000009:adverse effects / Q000266:history / Q000401:mortality / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coarctation Angioplasty; Pediatric Cardiac Intervention; Percutaneous Device Closure; Radiation Exposure