1
|
Sharma A, Vadher A, Shaw M, Malhi AS, Kumar S, Singhal M. Basic Concepts and Insights into Aortopulmonary Collateral Arteries in Congenital Heart Diseases. Indian J Radiol Imaging 2023; 33:496-507. [PMID: 37811182 PMCID: PMC10556305 DOI: 10.1055/s-0043-1770344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Aortopulmonary collateral arteries are persistent embryological vessels supplying lung parenchyma in various cardiopulmonary diseases with underlying pulmonary hypoperfusion. Their identification and mapping are important because of associated clinical implications and tendency to affect the surgical outcome. This article describes the embryological development and clinical relevance of aortopulmonary collaterals in various congenital cardiopulmonary conditions, along with the significance for treatment planning. Roles, strength, and shortcomings of the various imaging options and image-guided interventions are discussed, with a focus on presurgical planning and preparation, as well as postsurgical management.
Collapse
Affiliation(s)
- Arun Sharma
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akash Vadher
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Shaw
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder S. Malhi
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Manphool Singhal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
2
|
Jenab Y, Rezaee M, Hosseini K, Ghaderian H, Haddad RN, Zaidi AN. Percutaneous stent implantation for occluded central shunts in adults: A case report and review of current evidence. Front Cardiovasc Med 2022; 9:1032974. [PMID: 36479575 PMCID: PMC9720738 DOI: 10.3389/fcvm.2022.1032974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
Background Patients with cyanotic complex congenital heart defects (CHDs) commonly undergo palliation with interposition of systemic-to-pulmonary shunts (SPSs). These palliative shunts are rarely found in adults with CHDs and can be complicated with progressive obstruction or total occlusion during follow-up. The best treatment option for shunt re-permeabilization is challenging and case-oriented because most patients are high risk candidates for redo surgeries. We aimed to review the current evidence on percutaneous stent implantation to treat failed SPSs. Methods We performed a comprehensive literature review on percutaneous stent implantation to treat failed and occluded SPSs. We also reported the case of a 33-year-old man with cyanotic CHD and a occluded central aorto-pulmonary shunt, who was successfully treated with percutaneous balloon dilatation and subsequently stent implantation at our institution. Result We identified and included 31 articles reporting on 150 patients and 165 stent implantations in failed SPSs. The age of patients at the time of stent implantation ranged from 6 days to 47 years. The time between the surgical shunt creation and transcatheter intervention ranged from 1 day to 17 years. Overall, 161/165 (97.5%) stent implantations were successful. The most common clinical presentation was cyanosis and decreased atrial oxygen saturations and the indication for stent implantation was shunt obstruction and stenosis. Conclusion This review highlights the benefits of endovascular stenting to permeabilize failed SPSs in children and adults with complex CHD who are classified as poor candidates for re-surgical repair.
Collapse
Affiliation(s)
- Yaser Jenab
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Rezaee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Homa Ghaderian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran,*Correspondence: Homa Ghaderian,
| | - Raymond N. Haddad
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Ali N. Zaidi
- Mount Sinai Adult Congenital Heart Disease Center, Icahn School of Medicine, New York, NY, United States
| |
Collapse
|
3
|
Penford G, Quandt D, Mehta C, Bhole V, Dhillon R, Seale A, Stumper O. Stenting and overdilating small Gore-Tex vascular grafts in complex congenital heart disease. Catheter Cardiovasc Interv 2017; 91:71-80. [PMID: 29266703 DOI: 10.1002/ccd.27310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 08/05/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Gemma Penford
- Birmingham Children's Hospital, The Heart Unit; West Midlands United Kingdom
| | - Daniel Quandt
- Birmingham Children's Hospital, The Heart Unit; West Midlands United Kingdom
| | - Chetan Mehta
- Birmingham Children's Hospital, The Heart Unit; West Midlands United Kingdom
| | - Vinay Bhole
- Birmingham Children's Hospital, The Heart Unit; West Midlands United Kingdom
| | - Rami Dhillon
- Birmingham Children's Hospital, The Heart Unit; West Midlands United Kingdom
| | - Anna Seale
- Birmingham Children's Hospital, The Heart Unit; West Midlands United Kingdom
| | - Oliver Stumper
- Birmingham Children's Hospital, The Heart Unit; West Midlands United Kingdom
| |
Collapse
|
4
|
Kouatli A, Al-Ata J, Galal MO, Amin MA, Hussain A. Stent Implantation to Maintain Patency of a Stenosed Blalock Taussig Shunt. Asian Cardiovasc Thorac Ann 2016; 13:274-6. [PMID: 16113004 DOI: 10.1177/021849230501300318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 14-year-old female with complex congenital heart disease underwent a left-sided classical Blalock Taussig (BT) shunt 15 days after birth. Ten years after the operation her oxygen saturation had decreased significantly. An angiography revealed a severely stenosed BT shunt. Balloon dilation including implantation of a 6 × 13 mm stent was performed successfully. Immediately after intervention, oxygen saturation rose from 55% to 80 84% in room air. Follow-up at a year and a half later showed the classical BT shunt was still patent.
Collapse
Affiliation(s)
- Amjad Kouatli
- Section of Pediatric Cardiology, Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, P.O. Box 40047, Jeddah 21499, Saudi Arabia
| | | | | | | | | |
Collapse
|
5
|
Vaughn GR, Moore JW, Mallula KK, Lamberti JJ, El-Said HG. Transcatheter stenting of the systemic-to-pulmonary artery shunt: A 7-year experience from a single tertiary center. Catheter Cardiovasc Interv 2015; 86:454-62. [DOI: 10.1002/ccd.25926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 03/08/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Gabrielle R. Vaughn
- Division of Cardiology, Department of Pediatrics; UCSD School of Medicine and Rady Children's Hospital; San Diego California
| | - John W. Moore
- Division of Cardiology, Department of Pediatrics; UCSD School of Medicine and Rady Children's Hospital; San Diego California
| | - Kiran K. Mallula
- Division of Cardiology, Department of Pediatrics; UCSD School of Medicine and Rady Children's Hospital; San Diego California
| | - John J. Lamberti
- Division of Cardiovascular Surgery, Department of Pediatrics; UCSD School of Medicine and Rady Children's Hospital; San Diego California
| | - Howaida G. El-Said
- Division of Cardiology, Department of Pediatrics; UCSD School of Medicine and Rady Children's Hospital; San Diego California
| |
Collapse
|
6
|
Abstract
For more than 10 years, balloon-expandable intravascular stents have become an integral part of treatment for obstructive vascular lesions in children and adults with congenital heart disease. The initial problems with stents, such as sharp edges, rigid frame and unacceptable shortening when over-expanded have been overcome to a large extent with the newer designs. The problems related to delivery of stents, such as stent migration, balloon rupture, flaring of the edges of the stent, rupture of vessels and milking of the stent off the balloon, have also been overcome by newer designs of balloons. The failure of growth of balloon-expandable stents with the growth of the child is managed by redilation with or without additional stenting and newer growth stents. Self-expanding stents are not appropriate for use in growing children due to the limitation of their maximum diameters. The development of biodegradable stents may overcome these disadvantages in the future. Various new developments have recently occurred. Covered stents are ideal for treating acute vessel rupture and in isolating vascular aneurysms. Drug-eluting stents may prevent restenosis, but have not been used in children. Valved stents are a recent innovation for the treatment of regurgitant pulmonary valves.
Collapse
Affiliation(s)
- Shakeel Ahmed Qureshi
- Department of Pediatric Cardiology, Guy's Hospital, 11th Floor Guy's Tower, St Thomas Street, London SE1 9RT, UK.
| | | |
Collapse
|
7
|
Incani A, Lee JC, Nicolae MJ, Walters DL. Stenting an aortopulmonary conduit with peripheral cardiopulmonary bypass support. Catheter Cardiovasc Interv 2014; 83:E77-81. [PMID: 23592486 DOI: 10.1002/ccd.24952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/27/2013] [Accepted: 04/07/2013] [Indexed: 11/07/2022]
Abstract
Although surgically created aortopulmonary (AP) shunts are uncommon in the adult congenital heart disease population, they are often used in patients with pulmonary atresia. For these patients, the shunt is a vital supply of pulmonary blood flow and thus obstruction of the shunt may lead to pulmonary hypoperfusion and hypoxia thereby increasing morbidity and mortality. This report describes a safe and effective method of stenting the conduit with the hemodynamic support of peripheral cardiopulmonary bypass (PCB). Prior to the procedure, a multimodality assessment of a stenosis in a kinked AP conduit using computed tomography, angiography, intravascular ultrasound (IVUS), and pressure wire assessment (PWA) was utilized. While PCB, IVUS, and PWA have all been used to great effect in various clinical scenarios, the combined use of these techniques has not been previously been described in the setting of intervention in adult congenital heart disease.
Collapse
Affiliation(s)
- Alexander Incani
- Cardiology Program, The Prince Charles Hospital, Rode Rd, Chermside, Queensland, 4032, Australia; School of Medicine, University of Queensland, Herston Rd, Herston, Queensland, 4006, Australia
| | | | | | | |
Collapse
|
8
|
Venczelova Z, Tittel P, Masura J. First experience with andraStent XL implantation in children and adolescents with congenital heart diseases. Catheter Cardiovasc Interv 2012; 81:103-10. [DOI: 10.1002/ccd.24505] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 03/12/2012] [Accepted: 05/20/2012] [Indexed: 11/09/2022]
|
9
|
Suda K, Matsumura M, Matsumoto M. Stent implantation into vertical arterial duct in adult patient with cyanotic congenital heart disease. Ann Thorac Surg 2004; 79:e5-6. [PMID: 15620903 DOI: 10.1016/j.athoracsur.2004.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2004] [Indexed: 10/26/2022]
Abstract
A 26-year-old patient, who has double inlet left ventricle, pulmonary atresia, and a patent vertical arterial duct, presented with progressive cyanosis with an arterial oxygen saturation of 71%. He had had three shunt operations and only the last aortopulmonary shunt was patent. Angiography revealed a stenotic aortopulmonary shunt, stenotic vertical arterial duct, and a branch stenosis of the left pulmonary artery. He underwent successful stent implantation into both the aortopulmonary shunt and vertical arterial duct and his arterial oxygen saturation increased to 88%. This case report illustrates that stent implantation into a vertical arterial duct is feasible and can be an alternative to shunt operation.
Collapse
Affiliation(s)
- Kenji Suda
- Department of Pediatrics, Tenri Hospital, Tenri City, Japan.
| | | | | |
Collapse
|
10
|
Tyagi S, Dwivedi G, Gupta MD, Kaul UA. Stent implantation in right-sided patent ductus arteriosus to relieve severe cyanosis in adult patient with pulmonary atresia and ventricular septal defect. Catheter Cardiovasc Interv 2004; 61:271-4. [PMID: 14755827 DOI: 10.1002/ccd.10747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with unrepaired pulmonary atresia and ventricular septal defect may develop stenosis of collaterals or shunts to the pulmonary arteries leading to hypoperfusion of lungs and systemic hypoxemia. A 25-year-old female with pulmonary atresia and ventricular septal defect presented with progressively increasing cyanosis and exercise intolerance. A restrictive right-sided patent ductus arteriosus was identified as the main source of pulmonary blood flow. We report transcatheter implantation of a balloon-expandable stent across the stenosed duct to augment the pulmonary blood flow as a palliative management option. Patient had immediate improvement in arterial oxygen saturation from 66% to 85% with excellent clinical improvement and stable oxygen saturation on 8 months of follow-up.
Collapse
Affiliation(s)
- Sanjay Tyagi
- Department of Cardiology, G.B. Pant Hospital and Maulana Azad Medical College, New Delhi, India, USA
| | | | | | | |
Collapse
|
11
|
Balci NC, Yalçin Y, Tunaci A, Balci Y. Assessment of the anomalous pulmonary circulation by dynamic contrast-enhanced MR angiography in under four seconds. Magn Reson Imaging 2003; 21:1-7. [PMID: 12620540 DOI: 10.1016/s0730-725x(02)00634-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to demonstrate the initial results of the dynamic contrast-enhanced MRA in under four seconds in the assessment of anomalous pulmonary circulation. We performed dynamic contrast enhanced MRA on ten patients with a temporal resolution of 2-3 sec for each phase. Five patients had pulmonary vascular anomaly and five patients had reconstructed pulmonary circulation. On nine patients catheter angiography was performed for the correlation. Dynamic contrast-enhanced MRA successfully demonstrated congenital pulmonary vascular anomalies and the pathway of anomalous pulmonary circulation in our series. With the improved temporal and spatial resolution, the dynamic contrast-enhanced MRA can be used in children and infants for the assessment of congenital vascular disease.
Collapse
Affiliation(s)
- N Cem Balci
- Department of Radiology, Florence Nightingale Hospital, Istanbul, Turkey.
| | | | | | | |
Collapse
|