Over 12,000 carotid angioplasty and stenting (CAS) procedures have been performed worldwide.¹ More than 130,000 carotid endarterectomies (CEA) are performed annually in the United States.² The FDA has already approved CAS with distal protection for high-risk patients. With the emerging data from ongoing trials demonstrating at least clinical equipoise with CEA, it is only a matter of time before CAS becomes the procedure of choice for patients with atherosclerotic carotid artery disease.^3,4 A wealth of experience in overcoming the technical difficulties and managing the complications that can be associated with endoluminal revascularization of the carotid artery has been accumulated, particularly at high-volume CAS centers, some of which have participated in the trials that have documented the safety of the CAS procedure.

In the last decade, primary percutaneous coronary intervention (PCI) has emerged as a superior strategy compared to thrombolytic therapy for coronary reperfusion in acute myocardial infarction patients.^1–4 It is associated with lower mortality and reinfarction rates, less recurrent ischemia, fewer hospital readmissions and less need for repeated revascularization, as compared to thrombolytic therapy, both within the first 30 days and during long-term follow-up. Nevertheless, recurrent ischemia and the need for further improvement in survival rates emphasized the need to find new techniques and adjunctive pharmacological therapy in order to reduce these events .^1,4–6

Approximately 1.1 million myocardial infarctions occur annually in the United States and result in about 500,000 deaths. Acute myocardial infarction (AMI) is the result of plaque rupture and thrombus formation, with subsequent occlusion of a coronary artery, resulting in myocardial ischemia and necrosis. The current American College of Cardiology/American Heart Association (ACC/AHA) guidelines classify patients with AMI as those with ST-segment elevation (STEMI), and those with non-ST-segment elevation (NSTEMI), with treatment strategies tailored accordingly.¹ The current standard of care for patients with STEMI involves urgent reperfusion of the infarct-related artery (IRA) by either fibrinolysis or percutaneous coronary intervention (PCI). Survival depends on timely treatment with either modality.

Treatment of in-stent restenosis (ISR) remains a major challenge in modern interventional cardiology.

Several U.S.-based studies have estimated the overall cost of illness for acute coronary syndrome (ACS).^1–5 However, these studies either do not address the costs of care for the growing group of patients who undergo coronary revascularization, or examine the typically younger, commercially-insured population.^1–4
The therapeutic approach for the ACS patient is the subject of numerous clinical studies and guidelines.^6–8 Consensus guidelines now recommend early invasive therapy for the high-risk ACS patients.⁸ The frequency of an early invasive strategy in ACS is reflected in data from the American College of Cardiology National Cardiovascular Data Registry indicating that over 60% of percutaneous coronary interventions (PCI) are performed in patients with ACS.⁹

The transradial approach for coronary diagnostic and therapeutic interventions is a well-established alternative to the conventional femoral and brachial approaches^1–5 and is now widely used in catheterization laboratories worldwide.⁶ Although the radial approach is technically more difficult, as shown by the learning cure seen with this technique even among operators who have extensive experience with the femoral or brachial approaches,^7,8 its growing popularity stems from major advantages over the transfemoral and transbrachial techniques.

Since its initial description in 1982,¹ percutaneous balloon dilation (PBD) has supplanted surgical valvotomy as the primary treatment modality for valvar pulmonary stenosis (PS) across all age groups. Short- and intermediate-term results are excellent,^2–6 with reported 10-year freedom from re-intervention rates up to 85%. However, late outcomes with respect to pulmonary valve competence, right ventricular (RV) function and growth are not defined. In this study, we detail the determinants of late outcomes of PBD for valvar PS during childhood. Right heart growth patterns in relation to baseline characteristics and late sequelae were also assessed.

Methods

Congenital pulmonary valve stenosis comprises 7.5% to 9% of all congenital heart defects. The pathologic features of the stenotic pulmonary valve vary; the most commonly observed pathology is what is described as a “dome-shaped” pulmonary valve. The fused pulmonary valve leaflets protrude from their attachment into the pulmonary artery as a conical, windsock-like structure. The size of the pulmonary valve orifice varies from a pinhole to several millimeters, most usually central in location, but can be eccentric. Raphae presumably fused valve commissures extending from the stenotic orifice to a variable distance down into the base of the dome-shaped valve. The number of the raphae may vary from zero to seven. Less common variants are unicommissural, bicuspid and tricuspid valves. Pulmonary valve ring hypoplasia and dysplastic pulmonary valves may be present in a small percentage of patients.

Plastic bronchitis is characterized by marked obstruction of the large airways by bronchial casts.^1,2 Bronchial casts take the shape of the bronchi of a lobe or a lung.³ These casts may result in mild symptoms or life-threatening disease, and diagnosis is usually made when casts are expectorated or removed by bronchoscopy.⁴ Casts are often a complication of underlying bronchial diseases associated with mucus hypersecretion, such as cystic fibrosis, asthma, allergic bronchopulmonary aspergillosis, bronchiectasis or bronchopulmonary infections.^5–8 Congenital and acquired cardiopathies have also been implicated in the formation of bronchial casts.² Nevertheless, this disorder has also been shown to occur in children with congenital cyanotic heart disease who have undergone cardiothoracic surgical procedures, most commonly the Fontan procedure.⁹ In 1997, Seear, et al.¹ separated bronchial casts into two wel

Plastic bronchitis is characterized by marked obstruction of the large airways by bronchial casts.^1,2 Bronchial casts take the shape of the bronchi of a lobe or a lung.³ These casts may result in mild symptoms or life-threatening disease, and diagnosis is usually made when casts are expectorated or removed by bronchoscopy.⁴ Casts are often a complication of underlying bronchial diseases associated with mucus hypersecretion, such as cystic fibrosis, asthma, allergic bronchopulmonary aspergillosis, bronchiectasis or bronchopulmonary infections.^5–8 Congenital and acquired cardiopathies have also been implicated in the formation of bronchial casts.² Nevertheless, this disorder has also been shown to occur in children with congenital cyanotic heart disease who have undergone cardiothoracic surgical procedures, most commonly the Fontan procedure.⁹ In 1997, Seear, et al.¹ separated bronchial casts into two wel