Interventions in Structural, Valvular and Congenital Heart
Disease - 2nd Edition
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Contents
Preface to the Second Edition xi 10 Percutaneous transfemoral access with
Foreword by Dr. Michael Tynan xiii big sheaths 119
Foreword by Dr. Martin Leon xv Noa Holoshitz and Ziyad M. Hijazi
Video Contents xvii
Contributors xxi 11 Percutaneous subclavian access 127
Christian Frerker, Ulrich Schäfer, and
Section 1 Karl-Heinz Kuck
Cardiac catheterization laboratory design
and diagnostic modalities 12 Access from the common carotid artery 131
Grazyna Brzezinska-Rajszys
1 How to design and operate a congenital-
structural catheterization laboratory 1
13 Transhepatic access 135
John P. Cheatham
Makram R. Ebeid
2 Operators’ credentials and institutional
requirements for congenital and structural 14 Transseptal left heart catheterization 145
heart disease 13 Guilherme V. Silva and Igor F. Palacios
Ziyad M. Hijazi and Ted Feldman
15 Percutaneous transapical access 153
3 Angiography 17 Robert Kumar, Chad Kliger, Vladimir Jelnin,
Lee Benson and Haverj Mikailian and Carlos E. Ruiz
4 Hemodynamics 39
16 Recanalization methods for postcatheter
Mustafa Al-Qbandi and Ziyad M. Hijazi
vessel occlusion 161
5 Transesophageal 2D and 3D Frank F. Ing
echocardiographic guidance 59
Joseph John Vettukattil 17 Transpericardial access 173
Randall J. Lee, Krzysztof Bartus, and Nitish
6 Intracardiac echocardiography (ICE) 67 Badhwar
Damien Kenny, Qi-Ling Cao, and Ziyad M. Hijazi
18 Surgical access (transapical, transatrial,
7 Intracardiac echocardiography by Ultra ICE 81 transaortic, femoral, subclavian) 179
Eustaquio M. Onorato, Francesco Casilli, and Mirko Doss
Mario Zanchetta
8 Cardiac computed tomography and Section 3
magnetic resonance imaging in the cath-lab 97 Fetal and early postnatal interventions
Robert Kumar, Vladimir Jelnin, Chad Kliger,
and Carlos E. Ruiz 19 Fetal cardiac interventions 185
Carlos A. C. Pedra, Simone R. F. Fontes Pedra,
and C. Fábio A. Peralta
Section 2
Vascular access 20 Special considerations in small children
9 Ultrasound guidance 113 and newborns 193
Jamie Bentham and Neil Wilson Martin B. E. Schneider
vi Contents
Section 4 32 Pulmonary valve disease: Pulmonary
Valves atresia 309
Zaheer Ahmad, Marhisham Che Mood,
21 Congenital aortic valve stenosis: and Mazeni Alwi
Background and valvuloplasty in
children and adults 209 33 Pulmonary valve disease: Pulmonary valve
Oleg Reich and Petr Tax in cyanotic heart defects with pulmonary
oligemia 319
22 Congenital aortic valve stenosis:
P. Syamasundar Rao
Special considerations in neonates 219
Alejandro J. Torres and William E. Hellenbrand
34 Pulmonary valve disease: Transcatheter
pulmonary valve implantation with the
23 Aortic stenosis in the elderly: Background,
Melody valve 323
indication for transcatheter treatment,
Sachin Khambadkone and Philipp Bonhoeffer
and clinical trial results 229
Sameer Gafoor, Jennifer Franke, Stefan Bertog,
35 Pulmonary valve disease: Transcatheter
and Horst Sievert
pulmonary valve implantation with the
24 Aortic valve stenosis in the elderly: Balloon Edwards SAPIEN valve 331
aortic valvuloplasty 245 Noa Holoshitz and Ziyad M. Hijazi
John L. Parks and Daniel H. Steinberg
36 Pulmonary valve disease: New
25 Aortic valve stenosis in the elderly: percutaneous pulmonary valves 339
Transcatheter aortic valve implantation— Damien Kenny, Massimo Caputo, and Ziyad
Edwards SAPIEN valve 251 M. Hijazi
Sa’ar Minha, Ron Waksman, and
Augusto D. Pichard 37 Mitral and tricuspid valve stenosis:
Percutaneous mitral valvuloplasty 349
26 Aortic valve stenosis in the elderly: Igor F. Palacios and Guilherme V. Silva
Transcatheter aortic valve implantation—
CoreValve 257 38 Mitral and tricuspid valve stenosis:
Eberhard Grube, Georg Nickenig, Nikos Percutaneous tricuspid valvuloplasty 361
Werner, and Jan-Malte Sinning R. Arora
27 Aortic valve stenosis in the elderly:
39 Mitral valve insufficiency: Background
Valve-in-valve implantations 265
and indications for treatment 367
Azeem Latib and Antonio Colombo
Sameer Gafoor, Jennifer Franke, Stefan Bertog,
and Horst Sievert
28 Aortic valve stenosis in the elderly: New
percutaneous aortic valves 273
Peter C. Block 40 Mitral valve insufficiency: Mitral valve
repair with the MitraClip 377
29 Aortic valve stenosis in the elderly: Embolic Mamoo Nakamura and Saibal Kar
protection during transcatheter aortic
valve implantation 279 41 Mitral valve insufficiency: Other new
Alexander Ghanem and Eberhard Grube mitral valve repair techniques 385
Ted Feldman
30 Pulmonary valve disease: Pulmonary
regurgitation—Background, indications 42 Mitral valve insufficiency: Transcatheter
for treatment, and clinical trial results 287 mitral valve implantation 391
Hitesh Agrawal, Damien Kenny, and Monique Sandhu, David Gregg, and
Ziyad M. Hijazi Daniel H. Steinberg
31 Pulmonary valve disease: Pulmonary 43 Tricuspid valve insufficiency: Background
valve stenosis 297 and indications for treatment 395
P. Syamasundar Rao Alexander Lauten and Hans Reiner Figulla
Contents vii
44 Tricuspid valve insufficiency: Melody 56 Atrial septal defect: Cardia ASD occluder 479
valve in the tricuspid position 401 Emanuela de Cillis, Tommaso Acquaviva, and
Phillip Roberts Alessandro Santo Bortone
45 Tricuspid valve insufficiency: SAPIEN 57 Atrial septal defect: Complications of
valve in the tricuspid position 405 device closure of ASDs 487
Kiran K. Mallula, Damien Kenny, and Jeremy Asnes and William E Hellenbrand
Ziyad M. Hijazi
58 Patent foramen ovale closure: Background,
46 Tricuspid valve insufficiency: Percutaneous indications for closure, and clinical trial
caval stent valve implantation for treatment results 495
of tricuspid insufficiency 413 Daniel H. Steinberg, Stefan Bertog, and Horst Sievert
Alexander Lauten and Hans Reiner Figulla
59 Patent foramen ovale closure: Amplatzer-
type PFO occluders 501
47 Tricuspid valve insufficiency: Catheter
Bernhard Meier and Fabien Praz
closure of paravalvular leaks 419
Sameer Gafoor, Jennifer Franke, Stefan Bertog,
60 Disorders of the atrial septum: Closure with
Daniel H. Steinberg, Laura Vaskelyte, Ilona
HELEX or Gore septal occluder 523
Hofmann, and Horst Sievert
Matt Daniels and Neil Wilson
48 Tricuspid valve insufficiency: Catheter 61 Patent foramen ovale closure:
closure of perforated sinus of Valsalva 427 Premere septal occluder 533
Prafulla Kerkar and Joseph DeGiovanni Franziska Buescheck and Horst Sievert
Section 5 62 Patent foramen ovale closure: PFM PFO
occluder 541
Septal defects Tina Edwards-Lehr, Jennifer Franke, Stefan
49 Atrial septal defect: Background Bertog, Kristina Renkhoff, and Horst Sievert
and indications for ASD closure 433
John L. Bass 63 Patent foramen ovale closure:
CoherexFlatStent occluder 545
50 Atrial septal defect: Amplatzer- type Ilona Hofmann, Stefan Bertog, and Horst Sievert
ASD occluders 437
Mustafa Al-Qbandi, Qi-Ling Cao, and 64 Patent foramen ovale closure:
Ziyad M. Hijazi SeptRx occluder 549
Katharina Malsch, Jennifer Franke,
51 The Figulla-Occlutech device 449 Stefan Bertog, and Horst Sievert
Carlos A. C. Pedra, Simone R. F. Fontes Pedra,
Rodrigo N. Costa, and Marcelo S. Ribeiro 65 Patent foramen ovale closure: Suture-based
PFO closure 553
Anthony Nobles
52 The Cera Lifetech device 457
Worakan Promphan
66 Patent foramen ovale closure: Other
new PFO closure techniques 557
53 ASD-R PFM device 463 Ilona Hofmann, Stefan Bertog, and Horst Sievert
Miguel A. Granja, Alejandro Peirone, Jesus
Damsky Barbosa, Alexandra Heath, and 67 Patent foramen ovale closure:
Luis Trentacoste Complications of device closure of PFOs 561
Lutz Buellesfeld and Stephan Windecker
54 Cocoon device 469
Worakan Promphan 68 Ventricular septal defect closure:
Background, indications for closure, and
55 Starway device 475 clinical trial results 567
Ting-Liang Liu and Wei Gao Shakeel A. Qureshi and Sebastian Goreczny
viii Contents
69 Ventricular septal defect closure: Closure 81 Right ventricular outf low tract obstruction 675
of congenital muscular VSD using the Jamie Bentham and Neil Wilson
Amplatzer-type muscular VSD occluders 575
Noa Holoshitz, Qi-Ling Cao, and Ziyad M. Hijazi 82 Pulmonary artery stenosis 681
Larry Latson
70 Ventricular septal defect closure: Closure of
perimembranous VSD using Amplatzer- 83 Pulmonary vein stenosis 689
type occluders 583 Lee Benson
Ting-Liang Liu and Wei Gao
84 Balloon dilation of aortic coarctation
71 Ventricular septal defect closure: Closure of and recoarctation 697
perimembranous VSD using PFM coil 591 Rui Anjos and Inês Carmo Mendes
Trong-Phi Le
85 Stenting in aortic coarctation and
72 Ventricular septal defect closure: transverse arch/isthmus hypoplasia 705
Postmyocardial and postsurgery VSDs 601 Shakeel A. Qureshi
Kevin P. Walsh and Carla Canniffe
86 Middle aortic syndrome 717
Section 6 Grazyna Brzezinska-Rajszys and Shakeel
A. Qureshi
Aortopulmonary shunts
73 Patent ductus arteriosus (PDA):
Background and indications for closure 611
Section 9
Jamie Bentham and Neil Wilson Hypertrophic obstructive cardiomyopathy
87 Catheter intervention for hypertrophic
74 Patent ductus arteriosus (PDA): PDA obstructive cardiomyopathy 725
occlusion with the Amplatzer-type devices 617 Stéphane Noble, Haran Burri, and
Zaheer Ahmad and Mazeni Alwi Ulrich Sigwart
75 Patent ductus arteriosus (PDA): PDA 88 Hypertrophic obstructive cardiomyopathy:
occlusion with coils 627 Radio-frequency septal reduction 733
R. Krishna Kumar Joseph DeGiovanni
76 Patent ductus arteriosus (PDA):
Aortopulmonary window 637 Section 10
Shakeel A. Qureshi Thoracic aneurysms
89 Thoracic aortic aneurysms 741
Section 7 Jose Pablo Morales and John Reidy
Fistulas
77 Systemic arteriovenous fistulas 645 Section 11
Grazyna Brzezinska-Rajszys Hybrid procedures
78 Pulmonary arteriovenous fistulas 653 90 A hybrid strategy for the initial
Miltiadis Krokidis and John Reidy management of hypoplastic left heart
syndrome: Technical considerations 745
79 Coronary artery fistulas 659 Mark Galantowicz and John P. Cheatham
Shakeel A. Qureshi
91 Alternative procedures for hypoplastic
left heart syndrome as a bridge to
Section 8
transplantation 757
Obstructions Ryan R. Davies and Jonathan M. Chen
80 Obstructions of the inferior and superior
vena cava 669 92 Intraoperative VSD device closure 767
Marc Gewillig Damien Kenny, Qi-Ling Cao, and Ziyad M. Hijazi
Contents ix
93 Intraoperative stent implantation 777 101 Left ventricular partitioning with the
Sameer Gafoor and Evan M. Zahn cardiokinetics device 839
I. Bozdag-Turan, S. Kische, R. Goekmen Turan,
Section 12 C. A. Nienaber, and H. Ince
Left atrial appendage closure
102 Implantable assist devices for heart failure
94 Background, indication for LAA closure, treatment 845
and clinical trial results 793 Saibal Kar and Takashi Matsumoto
Stefan Bertog, Laura Vaskelyte,
Ilona Hofmann, Jennifer Franke, 103 Devices for hemodynamic monitoring 849
Simon Lam, Sameer Gafoor, and Horst Sievert Wen-Loong Yeow, Neal Eigler, and Saibal Kar
95 Amplatzer cardiac plug 799 104 Neurohumoral remodeling for treatment
Fabian Nietlispach and Bernhard Meier of hypertension and heart failure 855
Stefan Bertog, Laura Vaskelyte,
96 Watchman device 805 Ilona Hofmann, Jennifer Franke,
Peter Sick Sameer Gafoor, and Horst Sievert
97 Coherex WaveCrest 811
Section 14
Brian Whisenant and Saibal Kar
Other procedures
98 Sentre heart 819 105 Catheter retrieval of intracardiac masses 863
Krzysztof Bartus and Randall J Lee Brian J. deGuzman, Albert K. Chin, and
Lishan Aklog
99 Other new endocardial and epicardial
techniques 827 Section 15
Annkathrin Braut, Jennifer Franke,
Stefan Bertog, and Horst Sievert
Complications of congenital, structural,
and valvular interventions
Section 13 106 How to avoid and manage major
complications 879
Devices for heart failure management
Howaida El Said and Andras Bratincsak
100 Extracorporeal ventricular assist devices 833
Johannes Wilde and Gerhard C. Schuler Index 889
Preface to the Second Edition
This book is intended as a practical guide for the inter- Some of the procedures covered in the book, such as fetal
ventional treatment of congenital, valvular, and structural interventions, hybrid procedures, mitral valve repair, are
heart disease for invasive cardiologists in the pediatric emerging techniques representing the forefront of inter-
and adult fields. You will appreciate that this second edi- ventional treatment today, and will not be practiced in
tion gives us the opportunity to report consolidated results every catheter laboratory. We have collated contributions
and increase the bibliography of established interventional from a team of expert interventionists throughout the
procedures. In keeping with the explosion of structural world in an effort to draw together, via the common link of
interventions in adults and the huge increase in transcath- catheter technology, an approach to congenital and struc-
eter aortic valve replacement we have recruited many new tural heart disease that results in a new emerging specialist,
authors who are pioneers and leaders in those fields. We the cardiovascular interventionist.
have also encouraged younger interventionists who we feel We hope this edition will go a little further than the first
write well and who will become leaders in the future. We to provide guidance and in-depth education to personnel
have also expanded the concept of the importance of imag- of all levels and disciplines involved in interventional car-
ing alongside the technical details of equipment and its safe diac catheterization. We see it as a tool of reference for all.
and effective delivery. Our aim is to see a well-thumbed copy in catheter lab view-
Where possible we have tried to emphasize practical ing rooms and coffee rooms throughout the world. Please
aspects of the procedures, including the important issues do send feedback to us if you perceive shortcomings or have
of indications and patient selection, potential pitfalls, and interests and techniques that you feel should be included in
complications. Greater understanding, technical know- future editions.
how, and wider availability of catheters, balloons, deliv-
ery systems, and devices have spread intervention into the Horst Sievert
realm of acquired valve disease, degenerative disease of the Shakeel A Qureshi
aorta, paravalve leakage, postinfarction ventricular septal Neil Wilson
defects, and closure of the left atrial appendage. Ziyad M Hijazi
Foreword by Dr. Michael Tynan
This is the second edition of the book Percutaneous so balloon dilation of valves and vessels became routine.
Interventions for Congenital Heart Disease, now with Stents and implantable occlusion devices were explored.
“Structural Heart Disease” preceding “Congenital Heart Devices have come and gone with technology improve-
Disease.” Thus, it encompasses almost everything that is ments so that defect closure is now effective and safe.
not atherosclerotic, inflammatory, or metabolic. The new Over these early years of the twenty-first century the rate
edition is considerably larger, with an additional 300 pages, of innovation appears almost exponential. What would
which includes 41 chapters. The contributors come from the pioneers such as Rashkind, Gianturco, and Gruentzig
all over the world representing rising talent as well as the make of the possibilities today? They would love it.
“Old Guard.” However, it still retains the essential “how to” This rapid development has been made possible by the
philosophy of the first edition and of the annual Frankfurt close cooperation between physicians and industry. It would
CSI course, which gave birth to the book. The expansion is be hard to overstate the importance of the contribution of
not just in pages but in concepts, such as the online video our colleagues in industry. But the number and complexity
resources that are incorporated. of the procedures dealt with in this book pose problems for
Having lived through this era of less invasive treatment trainers and trainees alike. It is in this area that the book
for heart disease, from the introduction of balloon atrial will be invaluable.
septostomy by Bill Rashkind in 1966, perhaps I should
not be astonished at the rapidity with which it has blos- Michael Tynan, MD, FRCP
somed, but I am astonished. The slow start in the 1960s has Emeritus Professor of Paediatric Cardiology
given way to ever-increasing momentum. In the 1980s and King’s College
1990s, the ideas and practice of peripheral vascular inter- London
ventionists were incorporated into pediatric cardiology and
Foreword by Dr. Martin Leon
Most knowledgeable interventional historians would argue is unique for several reasons. First, the diversity and com-
that the era of less-invasive nonsurgical cardiovascular ther- plexity of interventional skills required to safely and suc-
apy mushroomed when Andreas Gruentzig performed the cessfully treat both neonates and octogenarians with
first successful coronary angioplasty in 1977, fulfilling his advanced cardiac lesions is unprecedented. Second, the
dream to accomplish catheter-based percutaneous treatment intersecting physician groups are far-reaching, spanning
of vascular disease in alert, awake patients. Undoubtedly, pediatric and adult interventional cardiology, imaging spe-
Andreas would have delighted in the astounding develop- cialists (not just angiography, but also echocardiography,
ments of the ensuing decades, as disciples of his “simple” MR imaging, and CT angiography), and hybrid surgical
procedure applied creativity, technical acumen, and scien- therapists. Finally, since many of the cardiac anomalies
tific rigor to sculpt the burgeoning multidisciplinary sub- targeted for catheter-based treatment occur rarely, the focused
specialty of interventional cardiovascular therapeutics. interventionalists working in this rarified zone have clus-
Thus, a heritage has emerged within the interventional tered into a small, well-bonded fraternity. The purpose of
cardiovascular community. We believe that “less invasive” this textbook is to highlight the practical teaching experi-
is preferred, certainly by patients and also by the healthcare ences of this congenital, valvular, and structural interven-
system in general; and less-invasive means catheter-based, tional fraternity.
nonsurgical, whenever possible. We are technology addicts, This textbook serves as a comprehensive syllabus including
especially new gizmos which can shorten procedures, a virtual “who’s who” author list, representing the thought
improve outcomes, and expand treatment indications. We leaders from all allied fields under the umbrella of congenital,
are passionate about experimental and clinical research valvular, and structural heart disease. The organizational
and evidence-based medicine, which is fundamental to structure is both authoritative and intuitive with easy-to-
every important therapy change and to the interventional navigate sections beginning with the catheterization labo-
device development process. We rely heavily on adjunctive ratory environment, new imaging modalities for diagnosis
imaging—this is a visual subspecialty …echo/IVUS/OCT, and procedural guidance, vascular access, fetal and infant
MR/CT, “fusion” imaging, and other new invasive imaging interventions, valvular interventions, and marching through
modalities. We are passionate about the interface of clinical an orderly progression of every conceivable congenital and
medicine and the rapid communication of ideas, including structural lesion category, which has been managed using
educational meetings and physician training initiatives. We existing or proposed interventional therapies. Every section
have a vibrant entrepreneurial spirit, are risk-takers, and has been expanded and enhanced since the first edition
rapidly embrace new therapies. We strongly support and with new contributors and topics, representing the absolute
promote global and multidisciplinary collaborations. In latest in new devices, interventional techniques, and clinical
short, we have a cultural identity … innovation, strong indus- data descriptions. Clearly, the greatest area of expansion is
try partnerships, impatience leading to evolution and forward in the breakthrough area of interventional valve therapies,
motion; we have a need to stimulate change and to continu- especially transcatheter aortic valve implantation and new
ally reinvent ourselves, in pace with advances in biomedical mitral regurgitation therapies. The textbook has a familiar
science and technology! stylistic consistency emphasizing clinical treatment indica-
This second edition of Interventions in Structural, tions and practical operator technique issues with helpful
Valvular, and Congenital Heart Disease is the embodiment procedural “tips and tricks” and careful descriptions of
of our rapidly expanding subspecialty and now represents potential complications. The breadth of this textbook is
the definitive textbook covering all forms of nonvascular impressive extending from commonly recognized condi-
interventional therapies. The wastebasket term “structural” tions (such as an expanded section on left atrial appendage
heart disease refers to the newest and most diverse branch closure methodologies for atrial fibrillation), to less well-
of the interventional tree, embracing a potpourri of con- established domains, including innovations in interven-
genital, valvular, and acquired cardiovascular disorders, tional heart failure diagnosis and therapy.
previously left untreated or relegated to surgical therapy Lest one thinks that this textbook is merely a compen-
alternatives. This newcomer on the interventional horizon dium of obscure interventional oddities, this segment of
xvi Foreword by Dr. Martin Leon
the subspecialty is exploding and the topics in this text- all cardiovascular healthcare professionals, from the curi-
book represent the greatest potential growth area in all of ous to the diehard interventional practitioner. I expect as
interventional cardiovascular medicine. In 5 to 10 years it this field continues to transform in the future that subse-
is entirely conceivable that this small fraternity of interven- quent editions of this textbook will help to define the
tionalists focused on congenital, valvular, and structural unpredictable progress of this unique subspecialty.
therapies will multiply into an army of catheter-based ther-
apists with specialized operator skills, an advanced appre- Martin B. Leon, MD
ciation of cardiac imaging modalities, and a thorough clinical Professor of Medicine,
understanding of multivaried cardiac disease states. This Columbia University Medical Center
dramatically improved second edition of Interventions in Director, Center for Interventional Vascular Therapy
Structural, Valvular, and Congenital Heart Disease fills a Chairman Emeritus, Cardiovascular Research Foundation
medical literature void and should be heartily embraced by New York City
Video Contents
For users of the VitalSource® eBook:
The accompanying video files as indicated by the throughout the text can be accessed via links in the eBook. Please
see the front page of this text for login instructions. Alternately, you can use the URLs provided here.
No. Description URL
Video 5.1 3D Jet. http://goo.gl/3Xifcl
Video 7.1 Great vessel axial plane. http://goo.gl/YXAgna
Video 7.2 Guide wire crossing the interatrial septum. http://goo.gl/r4qnXR
Video 7.3 Parasagittal long axis four-chamber plane. http://goo.gl/7CW38U
Video 7.4 Profile of Amplatzer septal occluder implanted. http://goo.gl/gJRdXm
Video 13.1 The needle is directed medially, superiorly and posteriorly while http://goo.gl/pQEwlw
small amount of dilute contrast is injected to outline the hepatic
vein.
Video 13.2 Contrast is injected outlining the hepatic vein. http://goo.gl/DjDivW
Video 13.3 Hand injection outlines portal vein rather than the hepatic vein. http://goo.gl/gIVGxu
Video 13.4 The needle is guided toward the hepatic vein while contrast is being http://goo.gl/85B9g9
injected.
Video 13.5 Hand injection demonstrates thrombosis of the inferior baffle of http://goo.gl/pgiclw
Fontan patient. Thus the hepatic route could not be used.
Video 13.6 The wire is manipulated along the hepatic vein to the heart. http://goo.gl/I8CsxT
Video 13.7 Sheath advancement is facilitated by the straight wire course. The http://goo.gl/3aSuf1
dilator may need to be separated from the sheath while advancing
the sheath in small infants to avoid trauma to the heart.
Video 13.8 Transhepatic stenting of stenosed RV to PA conduit. http://goo.gl/cduQNG
Video 13.9 Balloon atrial septostomy is being performed in a 2-day-old new- http://goo.gl/BAxryP
born using the transhepatic approach.
Video 13.10 A pulmonary vein wedge angiogram using the transhepatic http://goo.gl/zT62zR
approach outlines the stenoses of Sano anastomosis in a patient
with hypoplastic left heart syndrome.
Video 13.11 A pulmonary vein wedge angiogram using the transhepatic http://goo.gl/mgd0Cx
approach outlines the stenoses of Sano anastomosis in a patient
with hypoplastic left heart syndrome.
Video 13.12 Dilated hepatic veins in a patient with single ventricle. http://goo.gl/8Yf9xK
Video 13.13 The transhepatic approach allowed the use of a relatively larger http://goo.gl/hPMq8Q
sheath for balloon angioplasty of coarctation in a patient with sin-
gle ventricle post-stage 1 palliation preserving the femoral artery.
Video 13.14 Transhepatic stenting of LPA in a Fontan patient with complex http://goo.gl/mhguiO
congenital heart disease consisting of heterotaxy syndrome, inter-
rupted IVC, and left SVC with no right SVC.
(continued)
