Papers by William Hellenbrand
The Annals of Thoracic Surgery, 2015
Right ventricular outflow tract (RVOT) conduit dysfunction is a limitation of the Ross procedure.... more Right ventricular outflow tract (RVOT) conduit dysfunction is a limitation of the Ross procedure. Transcatheter pulmonary valve replacement (TPVR) could alter the impact of conduit dysfunction and the risk-benefit balance for the Ross procedure. Retrospective review of databases from 3 prospective Melody TPV (Medtronic Inc, Minneapolis, MN) trials. Among 358 patients who were catheterized with the intent to implant a Melody TPV for RVOT conduit stenosis or regurgitation (PR) as part of 3 prospective multicenter studies, 67 (19%) had a prior Ross procedure. Of these, 56 (84%) received a Melody valve; in 5 of the 11 patients who did not, the implant was aborted due to concern for coronary artery compression, and 1 implanted patient required emergent surgery for left coronary compression. The RVOT gradient decreased from a median 38 mm Hg to 13.5 mm Hg (p < 0.001). There was no or trivial PR in all but 4 patients, in whom it was mild. At a median follow-up of 4.0 years, 1 patient died from sepsis. Twelve patients underwent 14 transcatheter (n = 8) or surgical (n = 6) TPV reinterventions for obstruction with stent fracture (n = 9), endocarditis with conduit obstruction (n = 3), or reoperation (n = 2). Freedom from TPV explant was 89% ± 5% at 4 years. Among patients who did not undergo reintervention for obstruction, there was no change in RVOT gradient over time, and all but 1 patient had mild or less PR at last follow-up. The TPVR with the Melody valve provides acceptable early outcomes and durable valve function in the majority of Ross patients. Recurrent RVOT obstruction associated with stent fracture was the main reason for reintervention. Coronary compression is not uncommon in Ross patients and should be assessed prior to TPVR.
Catheterization and Cardiovascular Diagnosis, 1997
Successful stent implantation for conduit stenosis has been described; however, this procedure ma... more Successful stent implantation for conduit stenosis has been described; however, this procedure may be complicated by compression of adjacent structures during expansion. We report on a rare case of a single right coronary artery system complicating stent implantation for relief of homograft stenosis in tetralogy of Fallot.
Circulation, Jan 2, 2015
Studies of transcatheter pulmonary valve (TPV) replacement with the Melody valve have demonstrate... more Studies of transcatheter pulmonary valve (TPV) replacement with the Melody valve have demonstrated good short-term outcomes, but there are no published long-term follow-up data. The US Investigational Device Exemption trial prospectively enrolled 171 pediatric and adult patients (median age, 19 years) with right ventricular outflow tract conduit obstruction or regurgitation. The 148 patients who received and were discharged with a TPV were followed up annually according to a standardized protocol. During a median follow-up of 4.5 years (range, 0.4-7 years), 32 patients underwent right ventricular outflow tract reintervention for obstruction (n=27, with stent fracture in 22), endocarditis (n=3, 2 with stenosis and 1 with pulmonary regurgitation), or right ventricular dysfunction (n=2). Eleven patients had the TPV explanted as an initial or second reintervention. Five-year freedom from reintervention and explantation was 76±4% and 92±3%, respectively. A conduit prestent and lower disc...
Catheterization and cardiovascular diagnosis, 1997
Successful stent implantation for conduit stenosis has been described; however, this procedure ma... more Successful stent implantation for conduit stenosis has been described; however, this procedure may be complicated by compression of adjacent structures during expansion. We report on a rare case of a single right coronary artery system complicating stent implantation for relief of homograft stenosis in tetralogy of Fallot.
Catheterization and cardiovascular diagnosis, 1996
We report the immediate results and the short-term follow-up in a group of selected patients with... more We report the immediate results and the short-term follow-up in a group of selected patients with coarctation of the aorta who underwent endovascular stent implantation. Balloon-expandable stents were implanted in 6 patients (mean age 19.8 +/- 5.1 years) with coarctation of the aorta (4 recurrent and 2 native) who underwent a total of 7 procedures (6 implantation and 1 further expansion). The systolic peak pressure gradient was decreased from 36.7 +/- 16.9 to 13.3 +/- 23.2 mm Hg (P < 0.005). There was a 66% increase in the mean coarctation diameter from 9.3 +/- 1.7 to 15.6 +/- 3.1 mm (P = 0.001) with the ratio of the coarctation to descending aorta diameter, measured at the level of the diaphragm, increasing from 0.49 +/- 0.1 to 0.81 +/- 0.2 (P < 0.005). The dilatation was successful in expanding the stent to an acceptable diameter in 5 of 6 patients. One patient underwent successful further expansion of a stent implanted 22 months previously. There were no immediate complicat...
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2015
Secundum atrial septal defect (ASD) closure devices were granted approval based on industry-spons... more Secundum atrial septal defect (ASD) closure devices were granted approval based on industry-sponsored, prospective, nonrandomized, single device studies, demonstrating acceptable efficacy and safety in selected patients. We sought to report community practice and outcomes. Procedure specific data was collected on cases considered for ASD closure in the congenital cardiac catheterization project on outcomes (C3PO) between February 1, 2007 and June 31, 2010. Eight centers contributed data during this time period. All adverse events (AE) were independently reviewed and classified by a five level severity scale. In 40 months (2/07-6/10), 653 of 688 ASDs were occluded with a single device using an AMPLATZER(®) Septal Occluder (ASO) in 566 (87%), GORE(®) HELEX(®) Septal Occluder (HSO) in 33 (5%), and a CardioSEAL(®) or STARFlex™ device (CSD) in 54 (8%). Most patients had an isolated ASD (93%). 85% were >2 years of age. The ASD median diameter was 12 mm [8,16] for ASO, with smaller diam...
Annals of Thoracic Surgery, 2007
Pulmonary atresia with intact ventricular septum (PAIVS) has a wide spectrum of anatomic heteroge... more Pulmonary atresia with intact ventricular septum (PAIVS) has a wide spectrum of anatomic heterogeneity and invokes a wide variety of treatment strategies. We reviewed the outcome of our patients with PAIVS in order to delineate strategies for the optimal management of PAIVS. In particular, the possibility of avoiding neonatal surgical intervention with catheter-based technology was assessed. The study cohort was composed of all patients presented with PAIVS from January 1999 through December 2005. Demographic and anatomic variables were analyzed to determine association with in-hospital mortality. Forty-four infants with PAIVS underwent catheter valvuloplasty (n = 17) and (or) surgical intervention (n = 42). The mean age and weight of the infants was six days and 3.1 kg, and the average follow-up was 40 +/- 29.5 months. Five (11%) had right ventricle dependent coronary circulation (RVDCC) and six (14%) had Ebstein&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s anomaly. Five (11%) patients died. Of those who underwent catheter valvotomy, three (18%) underwent shunt placement, 12 (71%) underwent right ventricular outflow tract reconstruction with shunt placement, and only two (12%) did not require a further surgical intervention in the newborn period. Multivariable analyses demonstrated RVDCC (odds ratio 21.3, p = 0.025) and Ebstein&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s anomaly (odds ratio 16.0, p = 0.038) to be risk factors for in-hospital mortality. Of those patients with Ebstein&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s anomaly, a single ventricle approach had a better outcome. We demonstrated excellent recent outcomes for patients with PAIVS. Catheter-based interventions rarely avoid surgical repair. The RVDCC and Ebstein&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s anomaly were associated with high mortality. In patients with Ebstein&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s anomaly, single ventricular pathway may be the better strategy for this specific patient population.
Pediatric Critical Care Medicine, 2004
Pediatric Cardiology, 1988
A case of a massive benign intrapericardial teratonta that presented at two seeks of age with sig... more A case of a massive benign intrapericardial teratonta that presented at two seeks of age with significant respiratory distress is described . In retrospect, it is as discos eretl that this infant had been evaluated by fetal echocardiography while in utero at 20 "eeks of gestation due to a maternal history of surgically corrected tetrology of Fatlot. The fetal echocardiogram demonstrated normal intracardiac anatomy and no evidence of either a pericardial mass or effusion . It is concluded that this tumor spontaneously enlarged some time beliseen 20 and 40 weeks of gestation .
Pediatric Cardiology, 1987
This report describes a case of corrected transposition of the great arteries (TGA) in which a cl... more This report describes a case of corrected transposition of the great arteries (TGA) in which a classic subaortic membrane resulted in significant obstruction to outflow from the morphologically right ventricle. To our knowledge, discrete subaortic obstruction has not been previously reported with corrected TGA.
Pediatric Cardiology, 1989
We describe a case of unusual pulmonary vein-to-vein collateral formation leading to systemic des... more We describe a case of unusual pulmonary vein-to-vein collateral formation leading to systemic desaturation years following surgical repair of a sinus venosus atrial septa) defect and partial anomalous pulmonary venous return from the right lung . At surgery, a single right upper lobe pulmonary vein branch was left draining high into the superior vena cava (SVC), resulting in a small left-to-right shunt . SVC obstruction developed at the site of the ASD repair and elevated venous pressure above the obstruction caused retrograde flow into the unincorporated pulmonary vein . Pulmonary vein-to-vein collaterals formed between this unincorporated vein and an adjacent pulmonary vein that had been surgically diverted to drain into the left atrium, resulting in a right-to-left shunt within the right lung . Normal pulmonary veins drain multiple bronchopulmonary segments, thus providing potential collateral pathways . Balloon angioplasty of the SVC stenosis successfully relieved the obstruction and abolished the right-toleft intrapulmonary shunt .
Pediatric Cardiology, 1985
To evaluate complications and mortality following cardiac catheterization (CC) in patients under ... more To evaluate complications and mortality following cardiac catheterization (CC) in patients under one year of age, we prospectively examined 312 CC on 273 patients from the centers in the New England Regional Infant Cardiac Program during a one-year period. Among CC performed on patients less than four months old, the incidence of complications requiring treatment was 12%; for patients 4-12 months, it was 1.5% (p less than 0.02). By pre-CC risk assessment, 13% of CC were high risk, 21% medium risk, and 66% low risk. The incidence of major complications was much greater among the High Risk (30%) compared with Medium Risk (14%) (p less than 0.05) and with Low Risk (4%) (p less than 0.001). The overall mortality rates 24 h, 48 h, and one week after CC were 3.8%, 8.3%, and 13.5%, including patients with inoperable lesions and those having cardiac surgery, while deaths directly attributable to a CC complication were 0, 0.3%, and 0.3%, respectively. We can predict, prior to CC, the high-risk cases where major complications and death are likeliest to occur. The incidence of death from CC-related complications is extremely low in patients under one year of age, compared with death from the underlying lesion or following cardiac surgery.
The Journal of Thoracic and Cardiovascular Surgery, 2005
We reviewed our experience with repair of truncus arteriosus to assess the effect of type of righ... more We reviewed our experience with repair of truncus arteriosus to assess the effect of type of right ventricular outflow tract reconstruction on perioperative morbidity, survival, and freedom from catheter-based interventions and reoperation. Patients undergoing repair of truncus arteriosus from June 1990 through February 2004 were evaluated on the basis of operative procedure regarding preoperative and postoperative variables, the need for postoperative catheter-based intervention or reoperation, and survival on the basis of univariate, multivariable, and actuarial analyses. Of 54 study patients, 15 (28%) received a valved homograft, and 39 (72%) received a direct connection with a variety of hood materials. Five (9.1%) patients died. Valved homograft recipients were more likely to require reoperation than patients receiving direct connections (40% vs 15%, P = .046); however, valved homograft and direct connection recipients had a similar incidence of the combined end point of reoperation or catheter-based intervention (40.0% vs 37.5%, P = .865). Univariate and multivariable modeling demonstrated use of valved homografts or direct connections with an autologous pericardial hood to be predictive of the need for later catheter-based intervention or reoperation. Actuarial analysis demonstrated a trend toward improved outcomes in the direct connection group and within the direct connection cohort, a statistically significant difference on the basis of hood type. Although the direct connection technique might not prevent later catheter-based intervention, it does reduce the need for reoperation. Outcomes among direct connection recipients were associated with hood type: polytetrafluoroethylene hoods (W. L. Gore &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Associates, Inc, Tempe, Ariz) had the lowest rate of reintervention, and untreated autologous pericardial hoods had the highest rate of reintervention. We report excellent outcomes with primary repair of truncus arteriosus. Where anatomically appropriate, we advocate the direct connection technique.
Journal of the American College of Cardiology, 2004
We sought to review and report initial and one-year efficacy and safety results of the multicente... more We sought to review and report initial and one-year efficacy and safety results of the multicenter USA Amplatzer ductal occluder (ADO) device trial. BACKGROUND Transcatheter closure of a moderate to large patent ductus arteriosus (PDA) using conventional techniques is challenging. The ADO can close a PDA up to 12 mm in diameter.
Journal of the American College of Cardiology, 2000
This study was undertaken to evaluate the long-term results of balloon angioplasty (BA) for posts... more This study was undertaken to evaluate the long-term results of balloon angioplasty (BA) for postsurgical recoarctation in infants.
Journal of the American College of Cardiology, 2001
The aim of this study was to evaluate the use of endovascular stents in native and recurrent coar... more The aim of this study was to evaluate the use of endovascular stents in native and recurrent coarctation of the aorta (CoA). BACKGROUND Stents have been used successfully in various locations. Their use in CoA can be an alternative to surgery or balloon angioplasty (BA).
Journal of the American College of Cardiology, 2010
Background The congenital cardiac catheterization outcomes project (C3PO) was established to deve... more Background The congenital cardiac catheterization outcomes project (C3PO) was established to develop outcome assessment methods for pediatric catheterization.
Journal of the American College of Cardiology, 2002
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Journal of Pediatric Surgery, 1977
The technique of operative repair for coarctation of the aorta is now well standardized and the i... more The technique of operative repair for coarctation of the aorta is now well standardized and the immediate surgical mortality has been lowered to less than 5% in most large series. Long term follow up, however, is only recently being reported. This paper describes the current status of 100 consecutive patients who underwent elective resection from 1--13 yr ago. There was only one operative death. In contrast with other reports, residual systemic hypertension is rare in the 97 survivors. These observations confirm that coarctation of the aorta can be repaired surgically with an acceptable operative mortality; the outlook of the survivors appears excellent.
Journal of Pediatric Surgery, 1989
A newborn presented in congestive heart failure on the second day of life. Cardiac catheterizatio... more A newborn presented in congestive heart failure on the second day of life. Cardiac catheterization was normal, but aortic injection showed a congenital umbilical artery to umbilical vein arteriovenous malformation. Three similar cases have been reported. All four patients were successfully treated by complete excision of the malformation.
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Papers by William Hellenbrand