Expert Perspectives

Building a Level 1 Children’s Surgical Program at Hassenfeld Children’s Hospital

The director of children’s surgical services discusses key elements for achieving high-quality, family-centered care.

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Hassenfeld Children’s Hospital: A Leader in Advanced Pediatric Care

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Highest Level Children’s Surgery Verification

from the American College of Surgeons

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Best Congenital Cardiac Surgery

survival rates in New York State

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and Designated Regional Perinatal Center

Complex Case Spotlight

Transcatheter Management of a Rare Case of Congenital LV to CS Fistula


Intracardiac Anatomy Confirmed on MRI

The patient underwent electrophysiologic and cardiac catheterization studies on day 4 of life. The transesophageal electrophysiology study showed a moderate risk accessory pathway with the shortest pre-excited RR interval of 260 ms, antegrade effective refractory period of the accessory pathway of 270 ms, and no inducible atrial fibrillation. Angiography showed an LV to CS fistula.

Cardiac imaging shows the presence of a fistula from the base of the LV to the right atrium via the CS with an approximately 5:1 shunt.
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Successful Catheter Device Closure

The patient underwent device occlusion of the fistulous connection of the CS diverticulum to the LV on day of life 12. Each time a catheter or sheath was advanced across the CS orifice of the fistula, evidence of pre-excitation on the cardiac monitor ECG disappeared. Post-procedure transthoracic echocardiogram showed that the device was well positioned and there was no residual shunt.

An X-ray showing placement of the 8 mm Amplatzer Vascular Plug II device.
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Successful Radiofrequency Ablation of the Accessory Pathway

The patient was noted to have an accessory pathway in the CS diverticulum. Delta wave mapping was performed primarily during sinus rhythm. The earliest atrial electrogram was noted at -26 msec. Successful radiofrequency ablation of the accessory pathway was performed.

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Electrocardiogram showing delta wave mapping.
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