Electrosurgery in pediatric catheter interventions

Figures

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  Figure 1. After computed tomographic delineation (a) of the atretic pulmonary valve in tetralogy of Fallot with pulmonary atresia, right ventricular outflow tract (RVOT) angiogram (b) shows the atretic membrane and selective collateral angiogram (c) shows the central pulmonary arteries (PAs). After electrosurgical perforation and stenting, a direct communication (d) is established between RVOT and PA. RVOT: Right ventricular outflow tract, PA: Pulmonary artery, RPA: Right pulmonary artery, LPA: Left pulmonary artery, MPA: Main pulmonary artery

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  Figure 2. Atretic coarctation visualized on computed tomogram (a) confirmed by simultaneous distal arch and descending aortic stump injections (b) is electrosurgically perforated with a guidewire from a femoral catheter and snared by the radial catheter (c). A balloon dilatation using a 2 mm coronary balloon (d) facilitates advancement of a long sheath a long sheath for a covered stent angioplasty. Poststent angiogram in lateral (e) and anteroposterior (f) view shows complete relief of the coarctation. Arrow points to the atretic segment of coarctation

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  Figure 3. Progressive pulmonary arterial hypertension following surgical atrial septal defect pericardial patch closure required Brockenbrough needle perforation aided by electrosurgery (a) to allow implantation of atrial flow regulator (b)

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  Figure 4. Iatrogenic diversion of inferior vena cava (IVC) to the left atrium after surgical atrial septal defect closure shown on sagittal (a) and coronal (b) computed tomographic images is managed by electrosurgical puncture of the pericardial surgical patch (c) followed by covered stent redirection toward right atrium (RA) shown on IVC (d) and superior vena caval angiogram (e). Postprocedural computed tomography (f) confirms the redirection of IVC blood to RA. Arrow indicates hepatic veins. RUPV: Right upper pulmonary vein, IVC: Inferior vena cava, LA: Left atrium, RA: Right atrium, SVC: Superior vena cava

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  Figure 5. Left ventricular angiogram in left anterior oblique projection (a) after surgical closure of hypertensive ventricular septal defect shows intact surgical patch. As the pulmonary pressures are suprasystemic, electrosurgical guidewire perforation of the patch (b) is followed by small coronary balloon dilation (c) before advancing a larger guidewire and larger 16 mm balloon (d) to create a right ventricular decompression. LV: Left ventricular, RV: Right ventricular

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  Figure 6. Severe progressive pulmonary arterial hypertension after device closure of atrial septal defect shows a squashed underfilled left ventricle (a). After electrosurgical guidewire perforation (b) of the trabecular interventricular septum and formation of an arteriovenous circuit, stent angioplasty across the interventricular septum (c) decompresses the suprasystemic right ventricle and improves left ventricular filling (d). IVS: Interventricular septum, LV: Left ventricular, RV: Right ventricular

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  Figure 7. Aortogram in lateral view after many years of ductal ligation shows absence of residual flows (a). Electrosurgical guidewire perforation of the ligated region and snaring the wire (b) in the pulmonary artery allows a circuit formation to facilitate positioning a stent across the ligated duct (c) whose expansion establishes a reversed Potts shunt (d) to decompress the suprasystemic right ventricle. PA: Pulmonary artery, Ao: Aorta

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  Figure 8. Aortogram in anteroposterior view (a) in idiopathic severe pulmonary arterial hypertension identifies the potential puncture zone on the left wall of descending thoracic aorta adjacent to the left pulmonary artery (LPA) where a snare is placed to catch the electrosurgically advanced aortic guidewire (b) to form a circuit (c) that allows stenting between LPA and aorta thereby establishing reversed Potts shunt (d). PA: Pulmonary artery, LPA: Left pulmonary artery, Ao: Aorta

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  Figure 9. Pulmonary angiogram (a) through a failing Fontan conduit shows right pulmonary artery (RPA) and left pulmonary artery. Electrosurgical Brockenbrough needle perforation of the floor of RPA (b) allows placement of a stent (c) that creates a fenestration between the RPA and atrium (d). RPA: Right pulmonary artery, LPA: Left pulmonary artery

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  Figure 10. Right jugular sheath angiogram (a) after Glenn shunt shows right and left pulmonary arteries, while a simultaneous femoral venous access catheter angiogram shows superior vena caval stump. Snare in the pulmonary artery (PA) catches a guidewire advanced through an electrosurgically advanced Brockenbrough needle (b) and forms a circuit. A long covered stent advanced in this circuit is partially expanded in PA (c) and after confirming position, fully expanded (d) to create a transcatheter Fontan completion from the inferior vena cava and PA. RPA: Right pulmonary artery, LPA: Left pulmonary artery, SVC: Superior vena cava, PA: Pulmonary artery, IVC: Inferior vena cava

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  Figure 11. After multiple hemodialysis through various neck veins for many years, a complete venous occlusion of the right subclavian vein (a) is electrosurgically recanalized (b) using a guidewire to form a channel (c) that allows placement of a new hemodialysis cannula (d) in a patient with end-stage renal disease. SVC: Superior vena cava

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  Figure 12. A complete occlusion of the left pulmonary artery (LPA) many years after Glenn shunt is identified on transjugular angiogram (a) that shows a good-sized right pulmonary artery. Electrosurgical perforation of the occluded artery (b) is followed by LPA stent angioplasty (c) allowing a two-lung circulation (d) from the superior vena cava. LPA: Left pulmonary artery, RPA: Right pulmonary artery, SVC: Superior vena cava