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Patent ductus arteriosus The patent ductus arteriosus is a connection between the aorta and the pulmonary artery. PDA closure device Actual size of a patent ductus arteriosus closure device, a few millimeters. PDA closure The device is attached to the catheter which is positioned in the ductus arteriosus. It is deployed there to occlude it. CLOSURE OF THE PATENT DUCTUS ARTERIOSIUS in adults What is the patent ductus arteriosus? Patent ductus arteriosus is a birth defect that occurs when the ductus arteriosus, a normal connection between the aorta and pulmonary artery in the fetus, does not close properly after birth. Normally, this duct allows blood to bypass the lungs and go directly to the baby's system. However, after birth, blood must be oxygenated by the lungs, and the ductus arteriosus closes quickly, usually within a few days to two weeks . When the ductus arteriosus persists, some of the oxygenated blood, which should be redistributed to the rest of the body, returns to the lungs. This can lead to blood circulation problems and overload of the pulmonary system. So why is closure of the patent ductus arteriosus proposed? Restore normal circulation: Closing the ductus arteriosus restores normal blood circulation. Oxygenated blood can then be distributed efficiently throughout the body, without overloading the lungs. Preventing complications: Patent ductus arteriosus can lead to complications, such as lung infections, heart problems, and pulmonary hypertension . Closing the ductus arteriosus early reduces these risks. Improve quality of life: Closing the ductus arteriosus improves the patient's quality of life by avoiding the symptoms associated with this malformation. Depending on your medical assessment, you may be offered a prior right heart catheterization to determine the indication for closure of the ductus arteriosus. Procedure for closing the Arterial Duct: Your examination will take place in the interventional cardiology unit. Upon your admission to the cardiology department, you will be asked to wear a hospital gown. You will need to remove all your jewelry, underwear, and socks. A small area of your groin will be shaved, which will be the access point for the examination. A stretcher-bearer will take you to the catheterization room in your bed. You will be helped to lie down on a narrow, hard table. It might be a bit cold in the room. Around you, you will see X-ray analysis devices and screens. Small sticky patches will be placed on your chest. These will be connected to a heart monitoring device. Your body will be covered with a large sterile drape. The procedure involves the implantation of a metal mesh device in the arterial duct. This flexible device is implanted by cardiac catheterization via a puncture of the femoral vein under local anesthesia. In the absence of complications, the patient returns to their room and is monitored for 4 to 6 hours. Discharge is possible afterward. What are the complications of a ductus arteriosus closure procedure? Despite the experience of the operators and the significant technical progress concerning catheters and devices, this is an invasive procedure involving risks: allergic complications most often linked to the use of anesthesia products. Vascular complications at the femoral puncture site: the most common is a hematoma which results in a bluish appearance usually without consequence and disappearing after a few days. Rarely (<1% of cases), a vascular injury may require surgical repair or transfusion. cardiovascular complications during the hospital period : they are very rare (<0.5% of cases) of stroke, hemorrhagic effusion around the heart or displacement of the device, which may require additional intervention, sometimes surgical. Cardiac complications after hospital discharge : Very rarely, displacement of the deviceor localized infection may occur. complications leading to death : they are very exceptional (<0.1%). It is important to note that these complications are rare, and the benefits of ductus arteriosus closure usually outweigh the risks. PDA closure Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Insurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Thank your for your submission ! Demande d'information

Pulmonary valve stenosis Pulmonary valve valvuloplasty A. Waisting of the balloon used to dilate the pulmonary valve marks. B. Opening of the pulmonary valve with disappearance of the waist. PULMONARY VALVE DILATATION in adults Why are you being offered pulmonary valve dilatation? Pulmonary valve dilatation is a medical procedure to treat pulmonary stenosis, a condition where the pulmonary valve is too narrow, restricting blood flow from the heart to the lungs. This procedure is performed by inserting a catheter with a balloon at the tip through a vein and guiding it into the heart. Once inside the valve, the balloon is inflated and separates the valve cusps, allowing better blood flow . In rare cases, if balloon dilatation is not possible or effective, the pulmonary valve may be replaced with a bioprosthetic valve . Can I eat and drink before this test? You must be more than 12 hours before the exam. We try to respect the order and time of passage according to the organization of the day. However, depending on the emergencies of the day, the duration of the interventions of the day, it is possible to have a waiting time of several hours. Performing pulmonary valve dilatation: Pulmonary dilatation is performed in the catheterization room. The patient is conscious and lying flat. The doctor performs a venipuncture under local anesthesia at the groin. It is from this route that the doctor inserts a thin catheter into a large vein in the groin. The catheter is guided to the heart. An inflatable balloon is positioned at the pulmonary valve. Then, the balloon is inflated to widen the valve and improve blood flow. At the end of the procedure, the groin is compressed for about ten minutes, a pressure bandage is put on you and you will be asked to keep your leg straight for 4 hours. You can get up afterwards. You are usually discharged the next day. Are there risks associated with pulmonary valve dilatation? Despite technical advances and the experience of doctors, cardiac catheterization to dilate the pulmonary valve, like any invasive or surgical procedure, carries a risk of incidents or accidents: Allergic complications: Most often related to the use of iodinated radiological contrast or local anesthetic. If you have had allergic reactions before, it is imperative to inform your doctor. Complications at the puncture site of the vein: The most common complication is the formation of a bruise or hematoma at the puncture site, which can persist for several days but is usually inconsequential. Cardiac and vascular complications: During the examination, discomfort, chest pain, or palpitations related to a rhythm disorder may occur. Serious complications, however, are very rare. What benefits can be expected from pulmonary valve dilatation? Pulmonary valve dilatation offers several benefits for patients: Improved shortness of breath during exercise: After the procedure, you should feel less shortness of breath during physical activities and in your daily life. Your ability to tolerate exercise should improve, allowing you to participate in activities for longer periods of time. Improved quality of life: Pulmonary valve dilatation can reduce anxiety and depression, promoting a better quality of life. What is the follow-up after pulmonary valve dilatation? Dilatation of the pulmonary valve gives good results over many years. Follow-up with the cardiologist is annual and there are two possible developments: The valve has been dilated and over the years it will tighten. At that point, we can proceed to a new dilatation of the pulmonary valve. We can perform this procedure as many times as necessary, because it represents the best alternative to valve surgery. The valve has been dilated and over the years it has become leaky. At this point, we will have the choice of performing pulmonary revalvulation either by catheterization using a bioprosthesis or by surgery using a mechanical valve. Pulmonary valve stenosis Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Assurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Thank your for your submission! Demande d'information

Pulmonary valve stenosis Pulmonary valve dilatation A. Waisting of the balloon used to dilate the pulmonary valve marks. B. Opening of the pulmonary valve with disappearance of the waist. PULMONARY VALVE DILATATION in pediatrics What is pulmonary valve dilatation? Pulmonary valve dilatation is a medical procedure that aims to treat pulmonary stenosis, a condition where the pulmonary valve is too narrow, restricting blood flow from the heart to the lungs. This procedure is performed by inserting a catheter with a balloon at its tip through the femoral vein and guided to the heart. Once inside the valve, the balloon is inflated and separates the valve cusps, allowing better blood flow . Pulmonary dilatation can be performed at birth, if the newborn's adaptation to extra-uterine life is difficult (cyanosis), or during childhood if pulmonary stenosis affects the child's growth or ability to exercise. Performing pulmonary valve dilatation: Pulmonary dilatation is performed in the catheterization room. The child is laid flat and given general anesthesia so as not to move during the procedure. The doctor performs a venipuncture in the groin and inserts a thin catheter. The catheter is guided to the heart. An inflatable balloon is positioned at the pulmonary valve. Then, the balloon is inflated to widen the valve and improve blood flow. At the end of the procedure, the groin is compressed for about ten minutes and then a pressure bandage is applied. The child is monitored in the recovery room until he or she is fully conscious and then returned to the parents. Feeding is only allowed two hours after the end of the procedure to avoid the risk of aspiration. Discharge is usually the next day after an ultrasound check. Are there any risks associated with pulmonary valve dilatation? Despite technical progress and the experience of doctors, cardiac catheterization to dilate the pulmonary valve carries, as with any invasive or surgical procedure, a risk of incidents or accidents: Allergic complications: Most often linked to the use of iodinated radiological products or local anesthetics. If you have already experienced allergic manifestations, it is imperative to inform your doctor. Complications at the puncture site of the vein: The most common complication is the formation of a bruise or hematoma at the puncture site which can persist for several days, but is usually without consequence. Also, thrombosis, i.e. occlusion of the vein, can be mentioned. Cardiac and vascular complications: During the examination, palpitations may occur due to a rhythm disorder. Serious complications include cardiac perforation and tricuspid valve tear. These are rare but not negligible in the context of the emergency and the low weight of the infant. Failure of valvular dilation: Quite rare, it generally redirects the diagnosis towards a supravalvular stenosis, that is, arterial, which in this case requires surgical management. What benefits can be expected from pulmonary valve dilatation? Dilation of the pulmonary valve offers several benefits for the child: Normal height and weight growth. Improved exercise capacity: The child will have no limitations when playing and running. Improved cognitive abilities: The child will have fewer difficulties in learning and performing. What is the follow-up after pulmonary valve dilatation? Dilatation of the pulmonary valve gives good results over many years. Follow-up with the cardiologist is annual and there are two possible developments: The valve has been dilated and over the years it will tighten. At that point, we can proceed to a new dilation of the pulmonary valve. We can perform this procedure as many times as necessary, because it represents the best alternative to valve surgery. The valve has been dilated and over the years it has become leaky. At this point, we will have the choice of performing pulmonary revalvulation either by catheterization or surgery. Pulmonary valve stenosis Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Insurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Thank your for your submission ! Demande d'information

Atrial septal defect ASD is a hole between the atria. ASD closure device The device is an alloy of flexible metals (nickel and titanium). It contains a PTFE (Teflon) coating to make it waterproof. ASD closure The device is implanted between the two atria to close the ASD. ATRIAL SEPTAL DEFECT CLOSURE in adults Why are you being offered an ASD closure? An atrial septal defect (ASD) is a hole in the wall separating the two atria of the heart that is present during the embryonic stage and does not close after birth. Depending on the size of the ASD, it can cause exertional discomfort from a young age or may not present until adulthood, past the age of thirty. Additionally, it can lead to a stroke, a neurological complication that necessitates closure to prevent recurrence. Based on your medical evaluation, you may be offered a right heart catheterization beforehand to determine the indication for ASD closure. Can I eat and drink before this test? You must be more than 12 hours before the exam. We try to respect the order and time of passage according to the organization of the day. However, depending on the emergencies of the day, the duration of the interventions of the day, it is possible to have a waiting time of several hours. Performing the closing gesture: Your test will take place in the interventional cardiology unit. When you are admitted to the cardiology department, you will be asked to put on a hospital gown. You will need to remove all jewelry, underwear and socks. A small area of your groin will be shaved which will be the entrance route for the examination. A stretcher-bearer will take you to the catheterization room in your bed. You will be helped onto a narrow, hard table. It will be a little cold in the room. Around you, you will see X-ray machines and monitors. Small sticky patches will be placed on your chest. These will be connected to a heart monitoring machine. Your body will be covered with a large sterile drape. General anesthesia will begin. The procedure involves implanting a device comprising two metal mesh discs connected by a small connector and positioned on either side of the septum between the two atria to make it watertight. This flexible device is implanted by cardiac catheterization via a puncture of the femoral vein. This procedure is performed with ultrasound guidance (usually via transthoracic or transesophageal route), requiring general anesthesia or simple sedation. You will be asked to lie down for a few hours after the procedure. You will generally be discharged the day after the procedure after a transthoracic ultrasound scan. What are the expected benefits? Closing the ASD will balance the volumes between the heart chambers and reduce the dilation of the heart and therefore eliminate discomfort during exercise. What are the risks involved? Despite the experience of the operators and the significant technical progress concerning catheters and devices, this is an invasive procedure involving risks: allergic complications most often linked to the use of anesthesia products. Vascular complications at the femoral puncture site: the most common is a hematoma which results in a bluish appearance usually without consequence and disappearing after a few days. Rarely (<1% of cases), a vascular injury may require surgical repair or transfusion. cardiovascular complications during the hospital period : they are very rare (<0.5% of cases) of stroke, hemorrhagic effusion around the heart or displacement of the device, which may require additional intervention, sometimes surgical. Cardiac complications after hospital discharge : the most common complication is the occurrence of palpitations linked to a rhythm disorder (<5% of cases): generally early (first weeks) and transient, this arrhythmia may require an action or additional treatment if it persists. Much more rarely (<0.5% of cases), the formation of clots on the device or a displacement of the device may occur. complications leading to death : they are very exceptional (<0.1%). What follow-up after the device implantation? The implantation of the device requires taking a double antiplatelet treatment for a period of three to six months. No special physical or professional precautions are necessary after implantation of the device. This device also does not contraindicate any future exploration or intervention. Antibacterial prophylaxis will be offered in the event of risky extracardiac procedures during the 6 months following implantation of the device. Atrial septal defect closure Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 666 727 129 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Insurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Demande d'information Contact us Thank your for your submission ! Demande d'information

Mitral paravalvular leak The blue arrow indicates a mitral paravalvular leak, which was closed by a device. 3D transesophageal ultrasound image of the mitral valve White arrow: Mitral paravalvular leak. Black arrow: device closing a mitral paravalvular leak. Devices for paravalvular closures PARAVALVULAR LEAK CLOSURE What is a paravalvular leak? This is a leak located next to your valve prosthesis, which results in a backflow of blood into the heart cavity upstream. The cause of this leak is a more or less extensive detachment of the prosthesis that was surgically implanted in you. This detachment may be of infectious origin (endocarditis) or mechanical (tissue fragility, suturing difficulties related to calcifications present on your valve). It may exist since the post-operative period or appear secondarily. What are the consequences of a paravalvular leak? The leak results in increased workload on the heart and can lead to symptoms related to heart failure. The leak can also lead to abnormalities in the red blood cells (hemolysis) and therefore anemia. What are the possible consequences of a paravalvular leak? Not all paravalvular leaks indicate intervention. An intervention was proposed to you if your leak was deemed significant and responsible for symptoms. The standard treatment is surgical. In some cases, surgery was considered risky by a multidisciplinary team (risks related to reintervention or risk of recurrence), and percutaneous occlusion of the leak orifice may be proposed. The feasibility of the procedure is assessed by a multidisciplinary team, using imaging tests (transesophageal ultrasound (TEE) and cardiac CT scan). These tests are used to plan the procedure (size of the occlusion device to choose, possible anatomical difficulties). How is the percutaneous closure procedure performed? : The procedure will be performed under general anesthesia by a team of doctors trained in the technique. The team is composed of an anesthesiologist and a nurse anesthetist, two interventional cardiologists, an interventional sonographer and catheterization nurses. Given the technical nature of the procedure, a technical engineer mandated by the laboratory distributing the device may be present during your procedure. The procedure is guided by TEE. Anticoagulant treatment with heparin is administered at the beginning of the procedure and renewed if necessary during the procedure. Depending on the type of prosthesis affected, vascular access is via the femoral vein or artery. A guide is introduced to the location of the leak. Different catheters can be used to reach the orifice and cross it. The occlusion device is then introduced and deployed, the shape and size of which have been previously chosen using ultrasound evaluation. One or more devices may be required. The procedure lasts between 1.5 and 4 hours and requires general anesthesia. You will be hospitalized for a few days for monitoring and treatment adjustment. Our location Make an appointment LUH les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Insurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Thank your for your submission ! Demande d'information

Normal heart Blood from the right ventricle goes through the pulmonary valve into the pulmonary arteries. Pulmonary atresia with intact septum Blood from the right ventricle cannot go through the pulmonary valve, it comes out to find a passage between the atria. Dilatation of the pulmonary valve after perforation A. Waisting of the balloon used to dilate the pulmonary valve marks. B. Opening of the pulmonary valve with disappearance of the waist. NEONATAL PULMONARY VALVE PERFORATION What is pulmonary atresia with intact ventricular septum? Pulmonary atresia with intact ventricular septum (PA-IVS) is a rare congenital heart defect. In this condition, there is no passage between the right ventricle and the pulmonary artery. In other words, blood cannot flow normally to the lungs. The severity of this defect varies, but if the right ventricle is well developed, it becomes urgent at birth to open the pathway to the pulmonary arteries, in which case a puncture of the pulmonary valve is necessary. Procedure for Neonatal Pulmonary Valve Perforation: The perforation of the neonatal pulmonary valve is performed in the catheterization room. The newborn is placed under general anesthesia, lying on their back. The doctor performs a venous and arterial puncture in the groin area. From these access points, the doctor inserts thin catheters that are guided to the heart. The goal is to pass through the floor of the valve to position a balloon. The balloon is inflated to enlarge the valve and allow blood flow to the pulmonary arteries. At the end of the procedure, pressure is applied to the groin area for about ten minutes, and a compressive bandage is placed, which should be kept for a few hours. On the left, the angiography shows the absence of opacification of the pulmonary arteries. On the right, after perforation, the passage of the contrast agent to the pulmonary arteries can be seen. What are the risks of pulmonary valve perforation? Once again, pulmonary valve perforation addresses a non-viable cardiac malformation in its current state. Pulmonary valve perforation remains a life-saving procedure. What benefits can be expected from pulmonary valve perforation? After a perforation of the pulmonary valve, the following days guide us towards the continuation of the treatment: Either the lungs receive enough blood and the baby's growth is monitored without resorting to additional intervention. Either the lungs do not receive enough blood and we are forced to perform additional percutaneous or surgical intervention. Pulmonary atresia with intact septum Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Insurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Thank your for your submission ! Demande d'information

Coarctation of the aorta The narrowed aorta obstructs the flow of blood to the body's organs. Vascular stents a and b: uncovered stents. c and d: covered stents e: Dilatation balloon Aortic coarctation stenting Angiographic images of aortic coarctation before and after stenting. AORTIC COARCTATION STENTING in children What is coarctation of the aorta? Coarctation of the aorta is an abnormal narrowing of the aorta, the large blood vessel that carries blood from the heart to the rest of the body. This limits blood flow to organs and lower limbs. It can be present from birth (congenital coarctation) or develop later in life. The heart has to work harder to push blood through the narrowed part of the aorta. How to treat coarctation of the aorta? The interventional solution for coarctation of the aorta is stenting. Stenting reduces blood pressure in this area, thus relieving the heart and improving blood circulation . It widens the narrowed area, allowing blood to flow more freely. This improves perfusion of the abdominal organs and lower limbs, reducing the risk of complications . Stenting aims to improve quality of life and reduce the risks of cardiac and vascular complications associated with coarctation of the aorta . However, to perform this procedure, one must be able to ensure the accessibility of the femoral approach. The stent is introduced through the femoral artery, which must be of a good caliber. Generally, the stent can be considered after 8 - 10 years. In younger children, surgery will be discussed. In the neonatal period, for a rescue procedure, balloon dilation alone can be performed. Performing stenting of coarctation of the aorta: The child must fast for 12 hours before the examination. Stenting of the coarctation of the aorta is performed in the catheterization room. The child is laid flat and given general anesthesia so as not to move during the procedure. The doctor performs arterial punctures in the groin and inserts a thin catheter. The catheter is guided to the narrowed area of the aorta. The stent is deployed there to dilate the aorta. At the end of the procedure, compression is applied for about ten minutes at the groin level and then a pressure bandage is applied. The child is monitored in the recovery room until he or she is fully conscious and then returned to the parents. Food is only allowed two hours after the end of the procedure to avoid the risk of aspiration. Discharge is usually the next day after an ultrasound check. Are there any risks associated with coarctation of the aorta stenting? Despite technical progress and the experience of doctors, cardiac catheterization involves, as with any invasive or surgical procedure, a risk of incidents or accidents: Allergic complications: Most often linked to the use of iodinated radiological products or local anesthetics. If you have already experienced allergic manifestations, it is imperative to inform your doctor. Complications at the artery puncture site: This can range from a simple hematoma to a vascular injury or occlusion requiring surgical repair and/or blood transfusion. Cardiac and vascular complications: During the examination, discomfort, chest pain, palpitations related to a rhythm disorder may occur. Serious complications are very rare. The risk of death is very low. What follow-up after stenting of coarctation of the aorta? Stenting requires taking antiplatelet treatment for a period of 6 months. Antibacterial prophylaxis will be proposed in the event of risky extracardiac procedures during the 6 months following stent implantation. The child will be able to have a normal school life. He must continue the follow-up with his cardiologist, have a chest scan at 1 year. Depending on the child's growth, it may be necessary to repeat the procedure to dilate the previous stent or add a new stent. Coarctation of the aorta Stenting of coarctation of the aorta Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Assurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Thank your for your submission ! Demande d'information

Normal heart Pulmonary vascularization comes from the pulmonary arteries. Angiography of MAPCA Pulmonary vascularization comes from collaterals from the aorta. Embolization devices Coils: metal wires covered with PTFE (Teflon). The various closure devices composed of Nitinol and containing PTFE (Teflon). EMBOLIZATION OF COLLATERALS What are collaterals? In cyanotic congenital heart disease, that is, heart defects that cause a mixture of oxygenated and non-oxygenated blood, it is very common to find vessels that have developed to bring more blood to the arteries of the lungs; these vessels are called Multiple AortoPulmonary Collaterals Arteries (MAPCA). Veno-venous collaterals can also be found after palliation surgery for a univentricular heart. These collaterals can be objectified by ultrasound, cardiac scan, but above all it is necessary to perform a right heart catheterization to identify them and see their path. Pulmonary atresia with ventricular septal defect is a congenital malformation in which the newborn does not have continuity between the right ventricle and the pulmonary artery. Blood therefore reaches the pulmonary arteries via collaterals from the aorta, the MAPCAs. Should the MAPCAs be closed? The condition for occluding a MAPCA is that the flow delivered by the anterograde pathway (from the RV to the PA) is deemed to be sufficient for adequate pulmonary circulation. In this case, MAPCAs may contribute to increased blood flow to the lungs, leading to pulmonary hypertension . MAPCAs can therefore be closed pre-operatively because they can complicate surgery, or post-operatively if it is considered that closing them beforehand risks increasing oxygen depletion in the blood. Should veno-venous collaterals be closed? Veno-venous collaterals develop postoperatively in palliative surgery of a univentricular heart. They are closed when they cause significant clinical desaturation. How is a MAPCA embolization procedure performed? The procedure can be performed under local anesthesia, but for children under 14 years of age, deep sedation or general anesthesia is preferred so that they do not move. A puncture is performed in the groin and a catheter is passed along the artery or vein to the branch that we want to block. To embolize the artery, either coils or closure devices will be used. At the end of the procedure, the groin is compressed for about ten minutes and then a pressure bandage is applied. The child is monitored in the recovery room until he or she is fully conscious and then returned to the parents. Feeding is only allowed two hours after the end of the procedure to avoid the risk of choking. Discharge is usually the next day after an ultrasound scan. What are the complications of a collateral embolization procedure? Despite the experience of the operators and the significant technical progress concerning catheters and devices, this is an invasive procedure involving risks: allergic complications most often linked to the use of anesthesia products. Vascular complications at the femoral puncture site: the most common is a hematoma which results in a bluish appearance usually without consequence and disappearing after a few days. Rarely (<1% of cases), a vascular injury may require surgical repair or transfusion. Thrombosis of the artery can also occur. cardiovascular complications during the hospital period : they are very rare (<0.5% of cases) of stroke, hemorrhagic effusion around the heart or displacement of the device, which may require additional intervention, sometimes surgical. Cardiac complications after hospital discharge : Hemoptysis (coughing up blood). complications leading to death : they are very exceptional (<0.1%). It is important to note that these complications are rare, and the benefits of collateral occlusion usually outweigh the risks. Aortopulmonary collateral embolization Vascular embolization Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Insurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Merci pour votre envoi ! Demande d'information

Balloon catheter Multi-lumen catheter for performing right heart catheterization. Right heart catheterization The catheter is introduced into the different right heart chambers to take pressure and angiography measurements. RIGHT HEART CATHETERIZATION in adults What is right heart catheterization? Right heart catheterization, abbreviated as RHC, is a test that is performed to check how well your heart muscle is functioning. During this test, heart and blood pressure readings are taken and blood samples are taken to measure oxygen levels in the heart. This test is useful in finding the cause of pulmonary hypertension, determining its medication or interventional treatment, and deciding whether to have heart surgery in the case of congenital heart disease. Can I take my usual medications before the test? You can take most of your usual medications the night before your test and on the day of the test. Your doctor will review the medications you are taking with you. If you are unsure about any medication, you will need to let us know before you come. Can I eat and drink before this test? You can have a small snack on the day of the exam. Depending on the organization of the day, we try to respect the order and time of passage. However, depending on the emergencies of the day, the duration of the interventions of the day, it is possible to have a waiting time of several hours. How is right heart catheterization performed? Your test will take place in the interventional cardiology unit. When you are admitted to the cardiology department, you will be asked to put on a hospital gown. You will need to remove all jewelry, underwear and socks. You may wear your glasses, dentures, and hearing aids, if needed. A small area of your groin will be shaved in case it will be the entrance for the test. You will be asked to go to the bathroom to empty your bladder (urinate) just before your test. A stretcher-bearer will take you to the catheterization room in your bed. You will be helped onto a hard, narrow table. It will be a little cold in the room. Around you you will see X-ray machines and screens. Small sticky patches will be placed on your chest. These will be connected to a heart monitoring machine. Your body will be covered with a large sterile drape. The doctor will administer an anesthetic subcutaneously into the vein of your right arm or right groin to reduce the sensation of pain. Small catheters (tubes) are inserted into a vein into the right side of your heart. You may be asked to take a deep breath to help move the catheter. The doctor will measure the pressure in your heart and take blood samples to measure oxygen levels. If your ambient air saturation is low, an artery will be punctured to measure blood pressure and a blood sample will be taken to measure oxygen concentrations. The puncture will be made either at the wrist or in the groin crease. We may also perform angiograms, i.e. injections of contrast products. At this time, you may feel a sensation of heat throughout your body for a few seconds. The test lasts approximately 60 minutes. Are there any risks with this test? This procedure is safe and usually well tolerated, but there are still some risks. There may be bleeding at the insertion site, as well as pain and bruising. Additional heartbeats or palpitations (rapid heartbeats) may occur when the catheter is placed in your heart. It is very rare for this to cause problems, but you may experience such palpitations during the test. The risk of serious complications is very rare (less than 1%), but the benefit of the examination far outweighs the risks. How long will I be in bed after the test? If the procedure was performed using a vein in your arm, you will be able to get up as soon as you return to your room. If the procedure was performed from a vein in the groin, you must remain in bed for about two hours without bending the leg used for the puncture too much. The head of the bed can be slightly raised. After 2 hours of bed rest, you will be able to get up. When can I be discharged from the hospital? If the test was performed from a vein in the arm and without artery puncture, you will be able to leave 1 hour after the end of the examination. If the test was performed from a vein in the groin, you will be discharged approximately three hours after the procedure is completed. You will need to walk around and check for bleeding before you can consider discharge. It is recommended that you be picked up and taken home. It is important that someone be with you for a few hours after discharge in case you have any bleeding and need assistance. Cardiac catheterization Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Insurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Thank you for your submission. Demande d'information

Ventricular septal defect Ventricular septal defect is a hole between the ventricles Ventricular septal defect closure devices VSD Closure Percutaneous closure of ventricular septal defect using a device VENTRICULAR SEPTAL DEFECT CLOSURE in pediatrics What is a ventricular septal defect? In the normal heart, the wall separating the right and left ventricles, called the " interventricular septum ", is completely hermetic. Ventricular septal defect (VSD) corresponds to the presence of a more or less large orifice in this wall, allowing the direct passage of blood from one ventricle to the other. VSDs in children are said to be congenital (i.e. present at birth). The consequences of this malformation depend essentially on its size. Depending on the medical assessment, catheterization of the right heart cavities may be proposed before deciding on percutaneous closure of the VSD. So why is the closure of the VSD being proposed? Ventricular septal defect closure offers several benefits for patients. Here are some of them: Restore normal circulation: Closing the VSD restores normal blood circulation. Oxygenated blood can then be distributed efficiently throughout the body, without overloading the lungs. Preventing complications: Persistence of VSD can lead to complications, such as lung infections, valve infections, heart failure, and pulmonary arterial hypertension . Improved quality of life: After VSD closure, patients often experience a significant improvement in their quality of life. Dyspnea during feeding decreases, and growth retardation seen in infants improves. Procedure of VSD Closure: The examination takes place in the interventional cardiology unit. The child is laid flat and given general anesthesia so as not to move during the procedure. The doctor performs a venous and arterial puncture in the groin and inserts a thin catheter. The catheter is guided to the heart. The device is deployed in the VSD to close it. At the end of the procedure, the groin is compressed for about ten minutes and then a pressure bandage is applied. The child is monitored in the recovery room until he or she is fully conscious and then returned to the parents. Feeding is only allowed two hours after the end of the procedure to avoid the risk of aspiration. Discharge is usually the next day after an ultrasound check. What are the complications of a VSD closure procedure? The higher the child's weight, the lower the risk, but despite the experience of the operators and the significant technical progress in catheters and devices, it is an invasive procedure with complications: allergic complications most often linked to the use of anesthesia products. Vascular complications at the femoral puncture site: the most common is a hematoma which results in a bluish appearance usually without consequence and disappearing after a few days. Rarely (<1% of cases), a vascular injury may require surgical repair or transfusion. cardiovascular complications during the hospital period : they are very rare (<0.5% of cases) of stroke, hemorrhagic effusion around the heart or displacement of the devices, which may require additional intervention, sometimes surgical. Cardiac complications after hospital discharge : Very rarely, displacement of the device or localized infection may occur. complications leading to death : they are very exceptional (<0.1%). It is important to note that these complications are rare, and the benefits of VSD closure usually outweigh the risks. Ventricular septal defect Ventricular septal defect closure Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Insurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Thank your for your submission ! Demande d'information

Aortic valve stenosis Narrowing of the aortic valve restrict blood flow from the heart to the aorta and the rest of the body. Balloon dilatation of the aortic valve The balloon is inflated at the aortic valve to widen it. Balloon aortic valvuloplasty Angiographic image of aortic valve dilatation AORTIC VALVE DILATATION in pediatrics What is aortic valve dilatation? The aortic valve is one of the four valves of the heart and separates the left ventricle (the heart's pump) from the aorta (the largest blood vessel in the body). It allows blood to pass from the heart to the rest of the body. Narrowing of the aortic valve prevents blood from flow normally and becomes responsible for symptoms such as shortness of breath, angina, and heart failure. Aortic valve dilatation, also called aortic valvuloplasty, is offered in cases of aortic valve narrowing. It is usually a life-saving procedure in newborns, or scheduled in children. The goal of the procedure is to delay the need for heart surgery until adulthood. Performing aortic valve dilatation: Aortic dilatation is performed in the catheterization room. The child is laid flat and given general anesthesia so as not to move during the procedure. The doctor performs an arterial puncture in the groin and inserts a thin catheter. The catheter is guided to the heart. An inflatable balloon is positioned at the aortic valve. Then, the balloon is inflated to widen the valve and improve blood flow. At the end of the procedure, the groin is compressed for about ten minutes and then a pressure bandage is applied. The child is monitored in the recovery room until he or she is fully conscious and then returned to the parents. Feeding is only allowed two hours after the end of the procedure to avoid the risk of aspiration. Discharge is usually the next day after an ultrasound check. Are there any risks associated with aortic valve dilatation? Despite technical progress and the experience of doctors, cardiac catheterization to dilate the aortic valve involves, as with any invasive or surgical procedure, a risk of incidents or accidents: Allergic complications: Most often linked to the use of iodinated radiological products or local anesthetics. If you have already experienced allergic manifestations, it is imperative to inform your doctor. Complications at the puncture site of the artery: The most common complication is the formation of a bruise or hematoma at the puncture site which can persist for several days, but is usually without consequence. Also, we can cite thrombosis, that is to say the occlusion of the artery. Cardiac and vascular complications: During the examination, palpitations may occur due to a rhythm disorder. Serious complications include cardiac perforation and aortic valve tear. These are rare but not negligible in the context of the emergency and the low weight of the infant. What benefits can be expected from aortic valve dilatation? Aortic valve dilatation offers several benefits for the child: Normal height and weight growth. Improved exercise capacity: The child will have no limitations when playing and running. Improved cognitive abilities: The child will have fewer difficulties in learning and performing. What is the follow-up after aortic dilatation? Aortic valve dilatation, in the absence of significant leakage, gives good results over about ten years. Follow-up with the cardiologist is mandatory. The goal is to postpone the need for heart valve replacement surgery to the latest possible age. Aortic valve stenosis Balloon aortic valvuloplasty Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Insurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Thank your for your submission ! Demande d'information

Transposition of the great arteries Atrioseptostomy balloon The balloon measures 1 - 1.5 cm in diameter. RASHKIND ATRIAL SEPTOSTOMY What is the Rashkind atrial septostomie? The Rashkind atrial septostomy, also called Rashkind manoeuvre, is an interventional cardiology procedure performed as soon as possible after birth in newborns with transposition of the great arteries. In transposition of the great vessels, the pulmonary ("small circulation") and systemic ("large circulation") blood circulations occur in parallel rather than in series. The Rashkind maneuver aims to artificially create a wide communication between the right atrium and the left atrium. Performing the Rashkind maneuver: The procedure is performed as an emergency on a sedated newborn or under general anesthesia. A catheter with an inflatable balloon is introduced through the femoral vein or umbilical vein and directed into the left atrium via the foramen ovale. The balloon is inflated to enlarge this communication. The increase in arterial oxygen saturation assesses the effectiveness of the maneuver. Does Rashkind 's maneuver carry risks? Coronary complications : They can occur and represent the main cause of secondary mortality . Bleeding: As with any procedure, there is a risk of bleeding associated with the manipulation of blood vessels. Vascular damage: The catheter may damage blood vessels during insertion. Allergic reaction: The use of radiological contrast agents can cause allergic reactions in some patients. What benefits can we expect from Rashkind's maneuver? Rashkind maneuver allows better oxygenation of blood for efficient perfusion of organs and tolerating life. It is followed by cardiac repair surgery. Transposition of the great arteries Rashkind atrial septostomy Our location Make an appointment LUH Les Ambassadeurs : +212 (0) 6 22 22 26 31 Appointment Monday - Friday: 8 a.m. - 3:30 p.m. info@jakamyheartcenter.com Visit us map Insurance At Jakamy Heart Center, we understand the importance of easy and hassle-free insurance claim processing. Our team is here to help you verify your insurance coverage and answer any questions you may have. Feel free to contact us for personalized assistance. Our goal is to make your experience as pleasant as possible. We are committed to providing transparent and clear information about the insurance plans we accept. Contact us today to see if your insurance is accepted and to get the care you need. Check your insurance Request for information Contact us Thank your for your submission ! Demande d'information