{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T06:09:00Z","timestamp":1787983740351,"version":"build-2784847793"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T00:00:00Z","timestamp":1701648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>SwiftNINJA (Merit Medical Systems, USA) is a novel steerable microcatheter intended for coronary and peripheral vascular interventions. We evaluate and report the first use of SwiftNINJA in pediatric catheterization of congenital heart defects (CHDs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a retrospective clinical data review of children with CHDs in whom SwiftNINJA was used during cardiac catheterization between April 2022 and June 2023. Utility, application, and standard safety were described comprehensively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 19 patients (78.9% males) with a median age of 5.3 months (IQR, 2\u201313.9), and a median weight of 5.3\u2005kg (IQR, 4\u20137.7). 36.8% of the catheterizations were transarterial and 78.9% were interventional. SwiftNINJA was applied upfront in 3\/19 patients to cannulate precisely the right pulmonary artery and eliminate the risk of dislocating a freshly implanted left pulmonary flow restrictor. In 16\/19 patients, SwiftNINJA was applied after a median of 5 (IQR, 5\u20137) failed catheterization attempts using various combinations of catheters, microcatheters, and wires to cannulate challenging vasculature in seven, engage the lumen of stented vessels in five, cross complex aortic valve stenosis in three, and cross an apical ventricular septal defect in one patient with Damus-Kaye-Stansel repair. After the SwiftNINJA application, catheterization was done from the first attempt in 12\/16 patients and from the second attempt in 4\/16 patients. The median applied tip angulation was 90 degrees (IQR, 85\u201395). All procedures were completed successfully. No device malfunction or adverse events occurred.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>SwiftNINJA is a valuable addition for selective catheterization of challenging vasculatures or valvular anatomies in children with CHDs.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1322787","type":"journal-article","created":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T04:41:33Z","timestamp":1701664893000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["SwiftNINJA steerable microcatheter: a new kid on the block for selective catheterization of vascular and valvular congenital lesions"],"prefix":"10.3389","volume":"10","author":[{"given":"Raymond N.","family":"Haddad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Adel Hassan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Al Soufi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Kasem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,12,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e3337","DOI":"10.7759\/cureus.3337","article-title":"Welcome to the new era: a completely wireless interventional procedure","volume":"10","author":"Martin","year":"2018","journal-title":"Cureus"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1007\/s00270-014-0918-x","article-title":"Safety and efficacy of target vessel catheterization with the new steerable microcatheter direxion compared with a standard microcatheter: a prospective, preclinical trial","volume":"37","author":"Dudeck","year":"2014","journal-title":"Cardiovasc Intervent Radiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"41","DOI":"10.3109\/14017431.2013.875623","article-title":"Coronary sinus cannulation with a steerable catheter during biventricular device implantation","volume":"48","author":"Wang","year":"2014","journal-title":"Scand Cardiovasc J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e0143292","DOI":"10.1371\/journal.pone.0143292","article-title":"Comparison of conventional versus steerable-catheter guided coronary Sinus lead positioning in patients undergoing cardiac resynchronization device implantation","volume":"10","author":"Er","year":"2015","journal-title":"PLoS One"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.1007\/s00270-017-1789-8","article-title":"Experiments for the development of a steerable microcatheter","volume":"40","author":"Inaba","year":"2017","journal-title":"Cardiovasc Intervent Radiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s42155-019-0078-9","article-title":"Use of a steerable microcatheter during superselective angiography: impact on radiation exposure and procedural efficiency","volume":"2","author":"Hoffmann","year":"2019","journal-title":"CVIR Endovasc"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e3842","DOI":"10.7759\/cureus.3842","article-title":"Time is brain: the future for acute ischemic stroke management is the utilization of steerable microcatheters for reperfusion","volume":"11","author":"Harmon","year":"2019","journal-title":"Cureus"},{"key":"B8","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1007\/s00270-017-1579-3","article-title":"The steerable microcatheter: a new device for selective catheterisation","volume":"40","author":"Soyama","year":"2017","journal-title":"Cardiovasc Intervent Radiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e3469","DOI":"10.7759\/cureus.3469","article-title":"A novel nonvascular application of the steerable microcatheter","volume":"10","author":"Eadie","year":"2018","journal-title":"Cureus"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e3577","DOI":"10.7759\/cureus.3577","article-title":"Against the odds: a novel technique to perform cholangiography from a percutaneous approach through the cystic duct","volume":"10","author":"Padilla","year":"2018","journal-title":"Cureus"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e4125","DOI":"10.7759\/cureus.4125","article-title":"Pediatric traumas and paradigm shifts: the necessary adaption of the steerable microcatheter in pediatric interventional radiology","volume":"11","author":"Harmon","year":"2019","journal-title":"Cureus"},{"key":"B12","doi-asserted-by":"publisher","first-page":"54","DOI":"10.11909\/j.issn.1671-5411.2019.01.004","article-title":"Steerable microcatheters for complex percutaneous coronary interventions in octogenarians: from venture to swift ninja","volume":"16","author":"Kassimis","year":"2019","journal-title":"J Geriatr Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1150579","DOI":"10.3389\/fcvm.2023.1150579","article-title":"Outcomes of manually modified microvascular plugs to pulmonary flow restrictors in various congenital heart lesions","volume":"10","author":"Haddad","year":"2023","journal-title":"Front Cardiovasc Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.jss.2018.03.022","article-title":"Prolonged operative duration is associated with complications: a systematic review and meta-analysis","volume":"229","author":"Cheng","year":"2018","journal-title":"J Surg Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1016\/j.diii.2015.06.009","article-title":"Post-procedure bleeding in interventional radiology","volume":"96","author":"Mayer","year":"2015","journal-title":"Diagn Interv Imaging"},{"key":"B16","first-page":"65","article-title":"Percutaneous closure of ventricular septal defects in children: key parameters affecting patient radiation exposure","volume":"11","author":"Haddad","year":"2021","journal-title":"Am J Cardiovasc Dis"},{"key":"B17","first-page":"2610","article-title":"Shapability, memory, and luminal changes in microcatheters after steam shaping: a comparison of 11 different microcatheters","volume":"26","author":"Kiyosue","year":"2005","journal-title":"AJNR Am J Neuroradiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/s1051-0443(07)61890-9","article-title":"Use of a catheter with a large side hole for selective catheterization of the inferior phrenic artery","volume":"12","author":"Miyayama","year":"2001","journal-title":"J Vasc Interv Radiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.jvir.2015.10.022","article-title":"Balloon-assisted flow diversion and selective catheterization of target vessels for hepatic transarterial embolization","volume":"27","author":"Abdelsalam","year":"2016","journal-title":"J Vasc Interv Radiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1016\/j.asjsur.2021.11.002","article-title":"The SwiftNINJA steerable microcatheter for continuous hepatic artery infusion chemotherapy for the treatment of advanced intrahepatic cholangiocarcinoma","volume":"45","author":"Zhang","year":"2022","journal-title":"Asian J Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3205","DOI":"10.1016\/j.radcr.2022.06.011","article-title":"Successful treatment of chylous ascites by superselective embolization of the inflowing lymphatic vessels using a steerable microcatheter: a case study","volume":"17","author":"Hamaguchi","year":"2022","journal-title":"Radiol Case Rep"},{"key":"B22","first-page":"E148","article-title":"The use of a wire control catheter to treat complex pulmonary artery or vein anatomy","volume":"24","author":"Manica","year":"2012","journal-title":"J Invasive Cardiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/j.acvd.2021.06.002","article-title":"Transcatheter patent arterial duct closure in premature infants: a new technique to ease access to the patent arterial duct, with particular benefit for the tricuspid valve","volume":"114","author":"Meot","year":"2021","journal-title":"Arch Cardiovasc Dis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1002\/ccd.24646","article-title":"Multimodality 3D-roadmap for cardiovascular interventions in congenital heart disease\u2013a single-center, retrospective analysis of 78 cases","volume":"82","author":"Gl\u00f6ckler","year":"2013","journal-title":"Catheter Cardiovasc Interv"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.1007\/s00380-021-02007-6","article-title":"Embolization of vascular abnormalities in children with congenital heart diseases using medtronic micro vascular plugs","volume":"37","author":"Haddad","year":"2022","journal-title":"Heart Vessels"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1093\/ejcts\/ezx021","article-title":"Hypoplastic left heart syndrome: a novel surgical strategy for small-volume centres?","volume":"51","author":"Pontailler","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1002\/ccd.30611","article-title":"Transvenous retrograde thoracic duct embolization for effective treatment of recurrent plastic bronchitis after fontan palliation","volume":"101","author":"Haddad","year":"2023","journal-title":"Catheter Cardiovasc Interv"},{"key":"B28","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1093\/icvts\/ivy332","article-title":"Compact coil packing using a steerable microcatheter for a giant wide-necked pulmonary artery pseudoaneurysm","volume":"28","author":"Umakoshi","year":"2019","journal-title":"Interact Cardiovasc Thorac Surg"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1322787\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T04:41:43Z","timestamp":1701664903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1322787\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,4]]},"references-count":28,"alternative-id":["10.3389\/fcvm.2023.1322787"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2023.1322787","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,4]]},"article-number":"1322787"}}