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Panda BR, Mishra J. Delayed retrieval of embolized ductal stent: A surgical challenge. Ann Pediatr Cardiol 2024; 17:64-66. [PMID: 38933049 PMCID: PMC11198929 DOI: 10.4103/apc.apc_177_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/07/2024] [Accepted: 01/26/2024] [Indexed: 06/28/2024] Open
Abstract
Retrieval of embolized ductal stents from the pulmonary or systemic circulation can be challenging. Most children benefit from surgical shunts in such scenarios. Although early retrieval is advised, stents lodged in the peripheral pulmonary tree can be inaccessible, making the removal complicated. In such patients, stents can be "parked" in the segmental pulmonary arterial branches for retrieval later. In the low-pressure single ventricle pulmonary circulation, partially expanded embolized stents, if left in situ, can precipitate pulmonary arterial thrombosis. This subset of patients may benefit from meticulous anticoagulation and antiplatelet agents. In our case report, we describe the successful extraction of an embolized ductal stent without damage to the right lower lobe pulmonary artery (PA). In the follow-up evaluation, the growth of the right PA is good.
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Affiliation(s)
- Biswa Ranjan Panda
- Department of Cardiac Surgery, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Jayashree Mishra
- Department of Pediatric Cardiology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
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2
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Lemley BA, Wu L, Roberts AL, Shinohara RT, Quarshie WO, Qureshi AM, Smith CL, Dori Y, Gillespie MJ, Rome JJ, Glatz AC, Amaral S, O'Byrne ML. Trends in Ductus Arteriosus Stent Versus Blalock-Taussig-Thomas Shunt Use and Comparison of Cost, Length of Stay, and Short-Term Outcomes in Neonates With Ductal-Dependent Pulmonary Blood Flow: An Observational Study Using the Pediatric Health Information Systems Database. J Am Heart Assoc 2023; 12:e030575. [PMID: 38038172 PMCID: PMC10727347 DOI: 10.1161/jaha.123.030575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The modified Blalock-Taussig-Thomas shunt is the gold standard palliation for securing pulmonary blood flow in infants with ductal-dependent pulmonary blood flow. Recently, the ductus arteriosus stent (DAS) has become a viable alternative. METHODS AND RESULTS This was a retrospective multicenter study of neonates ≤30 days undergoing DAS or Blalock-Taussig-Thomas shunt placement between January 1, 2017 and December 31, 2020 at hospitals reporting to the Pediatric Health Information Systems database. We performed generalized linear mixed-effects modeling to evaluate trends in intervention and intercenter variation, propensity score adjustment and inverse probability weighting with linear mixed-effects modeling to analyze length of stay and cost of hospitalization, and generalized linear mixed modeling to analyze differences in 30-day outcomes. There were 1874 subjects (58% male, 61% White) from 45 centers (29% DAS). Odds of DAS increased with time (odds ratio [OR] 1.23, annually, P<0.01 [95% CI, 1.10-1.38]) with significant intercenter variation (median OR, 3.81 [95% CI, 2.74-5.91]). DAS was associated with shorter hospital length of stay (ratio of geometric means, 0.76 [95% CI, 0.63-0.91]), shorter intensive care unit length of stay (ratio of geometric means, 0.77 [95% CI, 0.61-0.97]), and less expensive hospitalization (ratio of geometric means, 0.70 [95% CI, 0.56-0.87]). Intervention was not significantly associated with odds of 30-day transplant-free survival (OR,1.18 [95% CI, 0.70-1.99]) or freedom from catheter reintervention (OR, 1.02 [95% CI, 0.65-1.58]), but DAS was associated with 30-day freedom from composite adverse outcome (OR, 1.51 [95% CI, 1.11-2.05]). CONCLUSIONS Use of DAS is increasing, but there is variability across centers. Though odds of transplant-free survival and reintervention were not significantly different after DAS, and DAS was associated with shorter length of stay and lower in-hospital costs.
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Affiliation(s)
- Bethan A. Lemley
- Division of CardiologyLurie Children’s HospitalChicagoILUSA
- Department of PediatricsFeinberg School of Medicine Northwestern UniversityChicagoILUSA
| | - Lezhou Wu
- Department of Biomedical and Health InformaticsChildren’s Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - Amy L. Roberts
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Russell T. Shinohara
- Department of Biostatistics, Epidemiology, and InformaticsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - William O. Quarshie
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Athar M. Qureshi
- Division of CardiologyTexas Children’s HospitalHoustonTXUSA
- Department of Pediatrics Baylor College of MedicineHoustonTXUSA
| | - Christopher L. Smith
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Yoav Dori
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Matthew J. Gillespie
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Jonathan J. Rome
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Andrew C. Glatz
- Division of CardiologySt. Louis Children’s HospitalSt. LouisMOUSA
- Department of PediatricsWashington University School of MedicineSt. LouisMOUSA
| | - Sandra Amaral
- Division of NephrologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of PediatricsPerelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
| | - Michael L. O'Byrne
- Division of CardiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaPAUSA
- Department of Pediatrics Perelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
- Clinical Futures, The Children’s Hospital of Philadelphia and Leonard Davis Institute and Cardiovascular Outcomes, Quality, and Evaluative Research CenterPerelman School of Medicine at The University of PennsylvaniaPhiladelphiaPAUSA
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3
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Successful treatment of re-coarctation of the aorta with percutaneous stent placement via axillary artery access in a young patient. Cardiol Young 2023; 33:315-317. [PMID: 35583098 DOI: 10.1017/s1047951122001639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In patients with critical coarctation of the aorta, percutaneous balloon angioplasty and/or stent placement is usually performed via the femoral route. When femoral access is not suitable for intervention, the trans-axillary approach can be chosen as an alternative access. We hereby present the first case of a patient who had a successful percutaneous stent placement via trans-axillary access in our institution.
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Agha HM, Abd -El Aziz O, Kamel O, Sheta SS, El-Sisi A, El-Saiedi S, Fatouh A, Esmat A, Abdelmohsen G, Hanna B, Hussien M, Sobhy R. Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. PLoS One 2022; 17:e0265031. [PMID: 35421117 PMCID: PMC9009684 DOI: 10.1371/journal.pone.0265031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
Percutaneous patent ductus arteriosus (PDA) stenting is a therapeutic modality in patients with duct-dependent pulmonary circulation with reported success rates from 80–100%. The current study aims to assess the outcome and the indicators of success for PDA stenting in different ductal morphologies using various approaches.
Methods
A prospective cohort study from a single tertiary center presented from January 2018 to December 2019 that included 96 consecutive infants with ductal-dependent pulmonary circulation and palliated with PDA stenting. Patients were divided according to PDA origin into 4 groups: Group 1: PDA from proximal descending aorta, Group 2: from undersurface of aortic arch, Group 3: opposite the subclavian artery, Group 4: opposite the innominate/brachiocephalic artery.
Results
The median age of patients was 22 days and median weight was 3 kg. The procedure was successful in 78 patients (81.25%). PDA was tortuous in 70 out of 96 patients. Femoral artery was the preferred approach in Group 1 (63/67), while axillary artery access was preferred in the other groups (6/11 in Group 2, 11/17 in Group 3, 1/1 in Group 4, P <0.0001). The main cause of procedural failure was inadequate parked coronary wire inside one of the branch of pulmonary arteries (14 cases; 77.7%), while 2 cases (11.1%) were complicated by acute stent thrombosis, and another 2 cases with stent dislodgment. Other procedural complications comprised femoral artery thrombosis in 7 cases (7.2%). Patients with straight PDA, younger age at procedure and who had larger PDA at pulmonary end had higher odds for success (OR = 8.01, 2.94, 7.40, CI = 1.011–63.68, 0.960–0.99, 1.172–7.40,respectively, P = 0.048, 0.031,0.022 respectively).
Conclusions
The approach for PDA stenting and hence the outcome is markedly determined by the PDA origin and morphology. Patients with straight PDA, younger age at procedure and those who had relatively larger PDA at the pulmonary end had better opportunity for successful procedure.
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Affiliation(s)
- Hala Mounir Agha
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
- * E-mail:
| | - Osama Abd -El Aziz
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Ola Kamel
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Sahar S. Sheta
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Amal El-Sisi
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Sonia El-Saiedi
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Aya Fatouh
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Amira Esmat
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Gaser Abdelmohsen
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Baher Hanna
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Mai Hussien
- Pediatric Department, General Organization of Teaching Hospitals and Institues, Cairo, Egypt
| | - Rodina Sobhy
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
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5
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Lekchuensakul S, Somanandana R, Namchaisiri J, Benjacholamas V, Lertsapcharoen P. Outcomes of duct stenting and modified Blalock-Taussig shunt in cyanotic congenital heart disease with duct-dependent pulmonary circulation. Heart Vessels 2021; 37:875-883. [PMID: 34714397 DOI: 10.1007/s00380-021-01978-w] [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: 06/14/2021] [Accepted: 10/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transcatheter ductus arteriosus stenting (DS) is emerging as an alternative method to modified Blalock-Taussig shunt (MBTS) in providing pulmonary blood flow in cyanotic congenital heart disease (CCHD) with duct-dependent pulmonary circulation. OBJECTIVE To evaluate post-procedural outcomes and survival between patients undergoing DS and MBTS. METHODS All infants ≤ 60 days of age having CCHD with diminished pulmonary blood flow who underwent palliative procedure either with MBTS or DS at King Chulalongkorn Memorial Hospital during January 1st, 2013 and December 31th, 2017 were retrospectively reviewed. RESULTS 98 patients were included; 34 patients underwent a transcatheter DS and 64 patients underwent MBTS. There was no significant difference in post-procedural outcomes and overall mortality rate between two groups (17.6% in MBTS group and 6.1% in DS group, p = 0.09). Single ventricle morphology was the major risk factor associated with increased mortality compared with biventricular morphology (aHR 3.9, 95% CI 1.49-10.2, p = 0.01). There was similar number of early and pre-repair additional interventions focusing on MBTS/DS patency between two groups. The MBTS group had a greater number of early interventions on PA branch stenosis related to baseline diagnosis. Risk factors associated with additional intervention were pre-existing pulmonary branch stenosis (aHR 2.54, 95% CI 1.3-4.97, p = 0.006) and body weight less than 2.5 kg (aHR 3.33, 95% CI 1.57-7.08, p = 0.003). Having pulmonic valve perforation or balloon pulmonary valvuloplasty to promote antegrade pulmonary blood flow could result in a lower number of additional interventions required before definitive repair. CONCLUSION Duct stenting is a feasible and safe alternative to MBTS in cyanotic infants with duct-dependent pulmonary circulation. However, mortality rate was significantly higher in patients with single ventricle that required careful follow-up after procedure.
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Affiliation(s)
- Sarin Lekchuensakul
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Cardiac Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
| | - Rattawanlop Somanandana
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Cardiac Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Jule Namchaisiri
- Cardiac Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.,Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vichai Benjacholamas
- Cardiac Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.,Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pornthep Lertsapcharoen
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Cardiac Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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6
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Bahaidarah S, Al-Ata J, Alkhushi N, Azhar A, Zaher Z, Alnahdi B, Abdelsalam M, Elakaby A, Dohain A, Abdelmohsen G. Outcome of ductus arteriosus stenting including vertical tubular and convoluted tortuous ducts with emphasis on technical considerations. Egypt Heart J 2021; 73:83. [PMID: 34542737 PMCID: PMC8452800 DOI: 10.1186/s43044-021-00210-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background Ductal stenting is the preferred method of securing adequate pulmonary blood flow in patients with duct-dependent pulmonary circulation. The main limitation in most centers is the difficult vertical tubular or convoluted ducts that represent real challenges to interventional pediatric cardiologists. We present our experience in patent ductus arteriosus (PDA) stenting with some technical tips to overcome difficulties, especially in stenting tortuous or long tubular ducts. This study was conducted on all patients with cyanotic congenital heart disease who underwent PDA stenting between January 2011 and December 2018. Results We attempted to stent the PDA in 43 patients, with a success rate of 93% (40 patients) and only one procedural mortality. There was also one stent migration that needed to be treated with urgent surgery. Three-fourths of the patients had difficult ductal morphology and origin. One stent was used to cover the PDA in 27 patients (62.8%), two stents were used in 13 (30.2%), and three stents were used in 2 patients (4.6%). In-stent stenosis rate was 12.5% (5 patients) and the development of progressive left pulmonary artery stenosis was seen in two patients (5%). Pulmonary artery growth was adequate in all patients. Conclusions PDA stenting is an effective method of palliation for patients with duct-dependent pulmonary circulation. It has low morbidity and mortality rates. Stenting difficult ducts have become more feasible with evolving materials and techniques. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-021-00210-4.
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Affiliation(s)
- Saud Bahaidarah
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Jameel Al-Ata
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Naif Alkhushi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmad Azhar
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Zaher Zaher
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Bayan Alnahdi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Mohamed Abdelsalam
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia.,Cardiology Department, Benha University, Benha, Egypt
| | - Ahmed Elakaby
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia.,Paediatric Department, Al-Azhar University, Cairo, Egypt
| | - Ahmed Dohain
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia.,Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, 11562, Egypt.,Paediatric Cardiology Division, Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt
| | - Gaser Abdelmohsen
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia. .,Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, 11562, Egypt.
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7
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Prabhu NK, Zhu A, Meza JM, Hill KD, Fleming GA, Chamberlain RC, Lodge AJ, Turek JW, Andersen ND. Transition to Ductal Stenting for Single Ventricle Patients Led to Improved Survival: An Institutional Case Series. World J Pediatr Congenit Heart Surg 2021; 12:518-526. [PMID: 34278866 DOI: 10.1177/21501351211007808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of systemic-to-pulmonary shunts (SPS) in neonates with single ventricle heart defects and ductal-dependent pulmonary blood flow (ddPBF) was historically associated with high morbidity and mortality at our center. As a result, we transitioned to the preferential use of ductus arteriosus stents (DS) when feasible. This report describes our initial results with this strategy. METHODS A single-center study of single ventricle patients that received DS or SPS from 2015 to 2019 was performed to assess whether DS was associated with decreased in-hospital morbidity and increased survival to stage II palliation. RESULTS A total of 34 patients were included (DS = 11; SPS = 23). Underlying cardiac anomalies were similar between groups and included pulmonary atresia, unbalanced atrioventricular septal defect, and tricuspid atresia. Procedure success was similar between groups (82% vs 83%). Two DS patients were converted to SPS, due to ductal vasospasm or pulmonary artery obstruction, and four SPS patients required surgical shunt revision. In DS patients, postprocedure mechanical ventilation duration was shorter (one vs three days, P = .009) and fewer required postprocedure extracorporeal membrane oxygenation (9% vs 39%, P = .11). A higher proportion of DS patients survived to stage II palliation (100% vs 64%, P = .035), and the probability of one-year survival was higher in DS patients (100% vs 61%, P = .02). CONCLUSIONS At our center, patients with single ventricle heart defects and ddPBF that received DS experienced reduced in-hospital morbidity and increased survival to stage II palliation compared to SPS.
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Affiliation(s)
- Neel K Prabhu
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,22957Duke University School of Medicine, Durham, NC, USA
| | - Alexander Zhu
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,22957Duke University School of Medicine, Durham, NC, USA
| | - James M Meza
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,Division of Cardiovascular and Thoracic Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA
| | - Kevin D Hill
- Division of Pediatric Cardiology, Department of Pediatrics, 22957Duke University Medical Center, Durham, NC, USA
| | - Gregory A Fleming
- Division of Pediatric Cardiology, Department of Pediatrics, 22957Duke University Medical Center, Durham, NC, USA
| | - Reid C Chamberlain
- Division of Pediatric Cardiology, Department of Pediatrics, 22957Duke University Medical Center, Durham, NC, USA
| | - Andrew J Lodge
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,Division of Cardiovascular and Thoracic Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA
| | - Joseph W Turek
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,Division of Cardiovascular and Thoracic Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA
| | - Nicholas D Andersen
- Congenital Heart Surgery Research and Training Program, 22957Duke University Medical Center, Durham, NC, USA.,Division of Cardiovascular and Thoracic Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA
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8
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Technical Modifications for Ductal Stenting in Neonates with Duct-Dependent Pulmonary Circulation. HEARTS 2021. [DOI: 10.3390/hearts2020015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The ductal stenting (DS) is currently an acceptable palliative treatment in newborns suffering with duct-dependent pulmonary circulation. However, this procedure remains technically a challenge in complex ductal morphology, which may eventually lead to detrimental outcomes. This review is mainly focused on pre-procedural planning, essential instruments and practical approaches for DS, and post-procedural care.
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9
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Esmaeili A, Schrewe R, Wong F, Schranz D. Axillary artery access for stenting of aortic coarctation in a 1.2 kg premature newborn with malignant systemic hypertension: a case report. Eur Heart J Case Rep 2021; 5:ytaa554. [PMID: 33598622 PMCID: PMC7873809 DOI: 10.1093/ehjcr/ytaa554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/07/2020] [Accepted: 12/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Axillary artery access is rarely used for demanding percutaneous transcatheter interventions. However, there are many clear advantages. CASE SUMMARY We describe this attractive approach in a 3-week-old premature neonate (bodyweight of 1.2 kg) with severe aortic coarctation. Percutaneous transcatheter intervention was performed with analgo-sedation and local anaesthesia; and a coronary stent was placed with a low fluoroscopy time of 2 min. Malignant systemic hypertension (160/54 mmHg) was effectively treated without any residual blood pressure gradient, with the aim for definitive surgery with stent resection and end-to-end anastomosis at the age of 6-12 months. DISCUSSION Axillary artery access is an attractive, alternative approach to treat newborns and premature infants with low body weight with complex heart diseases.
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Affiliation(s)
- Anoosh Esmaeili
- Department of Children and Adolescent Medicine, Pediatric cardiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Roland Schrewe
- Department of Children and Adolescent Medicine, Pediatric cardiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Flora Wong
- Monash Newborn, Children’s Hospital, Melbourne, Australia
- Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Paediatrics, Monash University Clinic, Melbourne, Australia
| | - Dietmar Schranz
- Department of Children and Adolescent Medicine, Pediatric cardiology, Frankfurt University Hospital, Frankfurt am Main, Germany
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10
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Li D, Zhou X, Li M. Arterial duct stent versus surgical shunt for patients with duct-dependent pulmonary circulation: a meta-analysis. BMC Cardiovasc Disord 2021; 21:9. [PMID: 33407150 PMCID: PMC7789398 DOI: 10.1186/s12872-020-01817-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 12/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Both systemic-pulmonary shunt and arterial duct stent could be the palliation of duct-dependent pulmonary circulation. We aimed to compare the safety and efficacy of the two approaches. METHODS The PubMed, EMBASE, and Cochrane Library databases were searched through December 2019 for studies comparing stent implantation and surgical shunt in duct-dependent pulmonary circulation. The baseline characteristics included ventricle physiology and cardiac anomaly. The main outcomes were hospital stay and total mortality. Additional outcomes included procedural complications, intensive care unit (ICU) stay, pulmonary artery growth at follow-up, and other indexes. A random- or fixed-effects model was used to summarize the estimates of the mean difference (MD)/risk ratio (RR) with 95% confidence intervals (CIs). RESULTS In total, 757 patients with duct-dependent pulmonary circulation from six studies were included. Pooled estimates of hospital stay (MD, - 4.83; 95% CI - 7.92 to - 1.74; p < 0.05), total mortality (RR 0.44; 95% CI 0.28-0.70; p < 0.05), complications (RR 0.49; 95% CI 0.30-0.81; p < 0.05) and ICU stay (MD, - 4.00; 95% CI - 5.96 to - 2.04; p < 0.05) favored the stent group. Significant differences were found in the proportions of patients with a single ventricle (RR 0.82; 95% CI 0.68-0.98; p < 0.05) or a double ventricle (RR 1.23; 95% CI 1.07-1.41; p < 0.05) between the stent and shunt groups. Additionally, pulmonary artery growth showed no significant differences between the two groups. CONCLUSION Arterial duct stent appears to have not inferior outcomes of procedural complications, mortality, hospital and ICU stay, and pulmonary artery growth in selected patients compared with a surgical shunt. TRIAL REGISTRATION CRD42019147672.
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MESH Headings
- Blalock-Taussig Procedure/adverse effects
- Blalock-Taussig Procedure/mortality
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/instrumentation
- Cardiac Catheterization/mortality
- Child
- Child, Preschool
- Ductus Arteriosus, Patent/diagnostic imaging
- Ductus Arteriosus, Patent/mortality
- Ductus Arteriosus, Patent/physiopathology
- Ductus Arteriosus, Patent/therapy
- Female
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/mortality
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/therapy
- Hemodynamics
- Humans
- Infant
- Infant, Newborn
- Length of Stay
- Male
- Palliative Care
- Pulmonary Artery/abnormalities
- Pulmonary Artery/diagnostic imaging
- Pulmonary Artery/growth & development
- Pulmonary Artery/surgery
- Pulmonary Circulation
- Recovery of Function
- Stents
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Dongxu Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Xu Zhou
- Evidence-Based Medicine Research Center, Jiangxi University of Traditional Chinese Medicine, Nanchang, People's Republic of China
| | - Mengsi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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11
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Evaluation of the Growth of Central Pulmonary Arteries Following Patent Ductus Arteriosus Stenting in Patients with Duct Dependent Pulmonary Circulation. Pediatr Cardiol 2020; 41:1667-1674. [PMID: 32720086 DOI: 10.1007/s00246-020-02426-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
Pulmonary arteries' (PAs) growth can be promoted by stenting of patent ductus arteriosus (PDA). This may result in better angle between the PDA and the PAs, allowing improved growth. In this study, we sought to evaluate the effect of PDA stenting on the growth of the pulmonary arteries by comparing their dimensions pre-stenting to their dimensions in the pre-second stage operations in patients with congenital heart diseases-duct-dependent pulmonary (CHD-DDP) circulation. Between January 2015 and December 2016, 58 neonates with CHD-DDP circulation underwent transcatheter PDA stenting and had evaluation of PAs growth before the second stage. Various parameters [Pre-branching right and left pulmonary artery (RPA, LPA) diameters, their Z scores, LPA/RPA ratio, McGoon's ratio and Nakata index] were recorded and compared pre-stenting and pre-second stage. The evaluation was done using catheterization or multislice computed tomography (MSCT). PDA stenting was successful in 49 patients out of 58 (84.5%) patients with an age of 13.5 ± 10.4 days and a weight of 2.9 ± 0.5 kg. Twenty-two (44.9%) patients had complex CHD-DDP, 14 (28.6%) patients had PA/IVS and 13 (26.5%) patients had PA/VSD. Pre-second stage RPA, LPA diameters and their Z scores increased significantly (RPA increased from 0.36 ± 0.05 cm to 0.60 ± 0.11 cm, P < 0.001, RPA Z-score increased from - 1.29 ± 0.91 to 0.81 ± 0.18, P < 0.001; LPA increased from 0.34 ± 0.06 cm to 0.58 ± 0.10 cm, P < 0.001, LPA Z-score increased from - 1.17 ± 0.86 to 0.97 ± 0.48, P < 0.001). McGoon's ratio increased significantly from 1.20 ± 0.11 to 1.61 ± 0.15 (P < 0.001). Nakata index increased from 105.94 ± 33.53 to 183.48 ± 40.58 mm2/m2 (P < 0.001). However, LPA/RPA ratio did not change (0.96 ± 0.05 and 0.98 ± 0.16, P = 0.288). PDA stenting is effective in promoting the global and the individual pulmonary artery growth in congenital heart diseases with duct-dependent pulmonary circulation. In this study, we presented our experience with this approach in 2 tertiary care centers in the DELTA region of Egypt. PDA stenting, generally, showed symmetric growth of the pulmonary arteries with comparable results to the international figures.
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12
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Haas NA, Fernandez-Rodriguez S, Dalla Pozza R, Fischer M, Ulrich S, Jakob A, Lehner A. Microcatheter-assisted stenting of the tortuous vertical ductus arteriosus via femoral access in a duct-dependent pulmonary circulation. Int J Cardiol 2019; 285:103-107. [PMID: 30851992 DOI: 10.1016/j.ijcard.2019.01.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/24/2018] [Accepted: 01/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stenting of the patent ductus arteriosus (PDA) has been accepted as alternative option to surgical shunting to enable additional pulmonary blood flow or for palliation of patients with a truly duct-dependent pulmonary circulation. The procedure can be challenging given the variable and often tortuous anatomy of the PDA and various technical approaches are reported. OBJECTIVE To report an alternative technique to treat tortuous ducts with microcatheter assistance and by transfemoral approach. METHODS We applied this technique of PDA stenting in 5 consecutive patients (4/5 age < 1 week, weight 2,7-3,2 kg; 1/5 re-do PDA stenting at 6,5 month and 5,9 kg). A soft coronary guidewire was advanced by microcatheter assistance into the branch pulmonary arteries and thereafter replaced by an extrastiff guidewire to enable the placement of long coronary stents. RESULTS Successful PDA stenting with this stepwise approach and with femoral access only could be achieved in all patients (n = 5/5). A single stent was used in 2 patients (one with re-do stenting and previous stents). 3/5 patients had 2 stents implanted by telescopic technique. Stent sizes used were 4,5 × 15 mm (n = 2) and 4,5 × 18 mm (n = 6). No guide wire or stent dislodgement appeared through all procedures with microcatheter assistance. CONCLUSIONS This technique enables PDA stenting via transfemoral approach in complex and tortuous ducts and thereby offers an attractive addition to the interventional management of truly duct-dependent pulmonary circulation.
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Affiliation(s)
- N A Haas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany.
| | - S Fernandez-Rodriguez
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - R Dalla Pozza
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - M Fischer
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - S Ulrich
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - A Jakob
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - A Lehner
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
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13
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Petit CJ, Qureshi AM, Glatz AC, McCracken CE, Kelleman M, Nicholson GT, Meadows JJ, Shahanavaz S, Zampi JD, Law MA, Pettus JA, Goldstein BH. Comprehensive comparative outcomes in children with congenital heart disease: The rationale for the Congenital Catheterization Research Collaborative. CONGENIT HEART DIS 2019; 14:341-349. [DOI: 10.1111/chd.12737] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/28/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Christopher J. Petit
- Sibley Heart Center Cardiology Department of Pediatrics Children’s Healthcare of Atlanta, Emory University School of Medicine Atlanta Georgia
| | - Athar M. Qureshi
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics Texas Children’s Hospital, Baylor College of Medicine Houston Texas
| | - Andrew C. Glatz
- The Cardiac Center, Children’s Hospital of Philadelphia Department of Pediatrics, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania
| | - Courtney E. McCracken
- Sibley Heart Center Cardiology Department of Pediatrics Children’s Healthcare of Atlanta, Emory University School of Medicine Atlanta Georgia
| | - Michael Kelleman
- Sibley Heart Center Cardiology Department of Pediatrics Children’s Healthcare of Atlanta, Emory University School of Medicine Atlanta Georgia
| | - George T. Nicholson
- Division of Cardiology, Department of Pediatrics Vanderbilt University School of Medicine Nashville Tennessee
| | - Jeffery J. Meadows
- Division of Cardiology, Department of Pediatrics University of California San Francisco School of Medicine San Francisco California
| | - Shabana Shahanavaz
- Section of Pediatric Cardiology, Department of Pediatrics Washington University School of Medicine St Louis Missouri
| | - Jeffrey D. Zampi
- Division of Cardiology, Department of Pediatrics CS Mott Children’s Hospital, University of Michigan School of Medicine Ann Arbor Michigan
| | - Mark A. Law
- Division of Pediatric Cardiology, Department of Pediatrics Children’s of Alabama, University of Alabama Birmingham School of Medicine Birmingham Alabama
| | - Joelle A. Pettus
- Sibley Heart Center Cardiology Department of Pediatrics Children’s Healthcare of Atlanta, Emory University School of Medicine Atlanta Georgia
| | - Bryan H. Goldstein
- The Heart Institute, Cincinnati Children’s Hospital Medical Center Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio
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14
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Lee J, Ratnayaka K, Moore J, El‐Said H. Stenting the vertical neonatal ductus arteriosus via the percutaneous axillary approach. CONGENIT HEART DIS 2019; 14:791-796. [DOI: 10.1111/chd.12786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/07/2019] [Accepted: 04/21/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Jesse Lee
- Division of Pediatric Cardiology Rady Children’s Hospital, University of California San Diego San Diego California
- Division of Pediatric Cardiology Baylor College of Medicine, The Children's Hospital of San Antonio San Antonio Texas Texas
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology Rady Children’s Hospital, University of California San Diego San Diego California
| | - John Moore
- Division of Pediatric Cardiology Rady Children’s Hospital, University of California San Diego San Diego California
| | - Howaida El‐Said
- Division of Pediatric Cardiology Rady Children’s Hospital, University of California San Diego San Diego California
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15
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Breatnach CR, Aggarwal V, Al-Alawi K, McMahon CJ, Franklin O, Prendiville T, Oslizlok P, Walsh K, Qureshi AM, Kenny D. Percutaneous axillary artery approach for ductal stenting in critical right ventricular outflow tract lesions in the neonatal period. Catheter Cardiovasc Interv 2019; 93:1329-1335. [PMID: 31020799 DOI: 10.1002/ccd.28302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/25/2019] [Accepted: 04/05/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We aimed to assess the experience using a percutaneous axillary artery approach for insertion of arterial ductal stents in patients with critical right ventricular outflow tract lesions at two tertiary pediatric cardiology centers. BACKGROUND Patent ductus arteriosus stenting is an accepted palliative alternative to BT shunts for neonates with critical right heart lesions. Access to tortuous ductus' may be challenging via the femoral artery, whereas the carotid artery presents a low risk of stroke. Recently, the axillary artery has been utilized for access in these patients. METHODS We performed a retrospective review of neonates who underwent stent placement or angioplasty using percutaneous axillary artery approach at two tertiary care centers from October 2016 to November 2018. Medical records were reviewed to ascertain demographic, clinical, and outcome data. RESULTS Axillary artery access was performed in 20 patients (16 primary ductal stents and 4 re-interventions) at a median (IQR) procedural weight of 3.4 (3-3.9) kg. Median (IQR) procedural time was 110 (75-150) min. The median (IQR) ICU stay and intubation times were 14 (0-94) hr and 5 (0-40) hr, respectively. There were three access-related vascular complications which were managed conservatively with no long-term effects. Two patients subsequently died due to non-procedure related causes. CONCLUSIONS Ductal stenting via a percutaneous axillary artery approach is a viable option in neonates with critical right ventricular outflow tract lesions. This approach provides an additional access site for PDA stenting which may be utilized in patients with vertical duct morphology.
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Affiliation(s)
- Colm R Breatnach
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | - Varun Aggarwal
- Department of cardiology, Texas Children's Hospital, Houston, Texas
| | - Khalid Al-Alawi
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | - Colin J McMahon
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | - Orla Franklin
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | | | - Paul Oslizlok
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | - Kevin Walsh
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
| | - Athar M Qureshi
- Department of cardiology, Texas Children's Hospital, Houston, Texas
| | - Damien Kenny
- Department of cardiology, Our Lady's Children's Hospital, Dublin 8, Ireland
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16
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Ductal flow reduction with covered coronary stents in neonates with pulmonary overflow after ductal stenting. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Rothman A, Dosani K, Evans WN, Galindo A. Stenting of the ductus arteriosus originating from the innominate or left subclavian artery in patients with a right aortic arch. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Faccini A, Butera G. Emergency transcatheter closure of a stented PDA in a patient with pulmonary atresia and intact ventricular septum: be ready for the unexpected! Clin Case Rep 2018; 6:317-322. [PMID: 29445470 PMCID: PMC5799631 DOI: 10.1002/ccr3.1337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 10/24/2017] [Accepted: 11/28/2017] [Indexed: 12/17/2022] Open
Abstract
Patients with congenital heart disease and duct‐dependent pulmonary circulation can undergo stenting of the patent ductus arteriosus (PDA). This case shows that, due to the physiological changes occurring after stent implantation, sometimes it is necessary to close the stented PDA rather than to redilate it.
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Affiliation(s)
- Alessia Faccini
- Department of Congenital Cardiology and Cardiac Surgery IRCCS Policlinico San Donato San Donato Milanese Italy
| | - Gianfranco Butera
- Department of Congenital Cardiology and Cardiac Surgery IRCCS Policlinico San Donato San Donato Milanese Italy
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19
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Glatz AC, Petit CJ, Goldstein BH, Kelleman MS, McCracken CE, McDonnell A, Buckey T, Mascio CE, Shashidharan S, Ligon RA, Ao J, Whiteside W, Wallen WJ, Metcalf CM, Aggarwal V, Agrawal H, Qureshi AM. Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-Dependent Pulmonary Blood Flow. Circulation 2018; 137:589-601. [DOI: 10.1161/circulationaha.117.029987] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/10/2017] [Indexed: 12/17/2022]
Abstract
Background:
Infants with ductal-dependent pulmonary blood flow may undergo palliation with either a patent ductus arteriosus (PDA) stent or a modified Blalock-Taussig (BT) shunt. A balanced multicenter comparison of these 2 approaches is lacking.
Methods:
Infants with ductal-dependent pulmonary blood flow palliated with either a PDA stent or a BT shunt from January 2008 to November 2015 were reviewed from the 4 member centers of the Congenital Catheterization Research Collaborative. Outcomes were compared by use of propensity score adjustment to account for baseline differences between groups.
Results:
One hundred six patients with a PDA stent and 251 patients with a BT shunt were included. The groups differed in underlying anatomy (expected 2-ventricle circulation in 60% of PDA stents versus 45% of BT shunts;
P
=0.001) and presence of antegrade pulmonary blood flow (61% of PDA stents versus 38% of BT shunts;
P
<0.001). After propensity score adjustment, there was no difference in the hazard of the primary composite outcome of death or unplanned reintervention to treat cyanosis (hazard ratio, 0.8; 95% confidence interval [CI], 0.52–1.23;
P
=0.31). Other reinterventions were more common in the PDA stent group (hazard ratio, 29.8; 95% CI, 9.8–91.1;
P
<0.001). However, the PDA stent group had a lower adjusted intensive care unit length of stay (5.3 days [95% CI, 4.2–6.7] versus 9.19 days [95% CI, 7.9–10.6];
P
<0.001), a lower risk of diuretic use at discharge (odds ratio, 0.4; 95% CI, 0.25–0.64;
P
<0.001) and procedural complications (odds ratio, 0.4; 95% CI, 0.2–0.77;
P
=0.006), and larger (152 mm
2
/m
2
[95% CI, 132–176] versus 125 mm
2
/m
2
[95% CI, 113–138];
P
=0.029) and more symmetrical (symmetry index, 0.84 [95% CI, 0.8–0.89] versus 0.77 [95% CI, 0.75–0.8];
P
=0.008] pulmonary arteries at the time of subsequent surgical repair or last follow-up.
Conclusions:
In this multicenter comparison of palliative PDA stent and BT shunt for infants with ductal-dependent pulmonary blood flow adjusted for differences in patient factors, there was no difference in the primary end point, death or unplanned reintervention to treat cyanosis. However, other markers of morbidity and pulmonary artery size favored the PDA stent group, supporting PDA stent as a reasonable alternative to BT shunt in select patients.
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Affiliation(s)
- Andrew C. Glatz
- Cardiac Center at the Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine (A.C.G., A.M., T.B., C.E.M.)
| | - Christopher J. Petit
- Children’s Healthcare of Atlanta, Emory University School of Medicine, GA (C.J.P., M.S.K., C.E.M., S.S., R.A.L., J.A.)
| | - Bryan H. Goldstein
- Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, OH (B.H.G., W.W., W.J.W., C.M.M.)
| | - Michael S. Kelleman
- Children’s Healthcare of Atlanta, Emory University School of Medicine, GA (C.J.P., M.S.K., C.E.M., S.S., R.A.L., J.A.)
| | - Courtney E. McCracken
- Cardiac Center at the Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine (A.C.G., A.M., T.B., C.E.M.)
| | - Alicia McDonnell
- Cardiac Center at the Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine (A.C.G., A.M., T.B., C.E.M.)
| | - Timothy Buckey
- Cardiac Center at the Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine (A.C.G., A.M., T.B., C.E.M.)
| | - Christopher E. Mascio
- Children’s Healthcare of Atlanta, Emory University School of Medicine, GA (C.J.P., M.S.K., C.E.M., S.S., R.A.L., J.A.)
| | - Subi Shashidharan
- Children’s Healthcare of Atlanta, Emory University School of Medicine, GA (C.J.P., M.S.K., C.E.M., S.S., R.A.L., J.A.)
| | - R. Allen Ligon
- Children’s Healthcare of Atlanta, Emory University School of Medicine, GA (C.J.P., M.S.K., C.E.M., S.S., R.A.L., J.A.)
| | - Jingning Ao
- Children’s Healthcare of Atlanta, Emory University School of Medicine, GA (C.J.P., M.S.K., C.E.M., S.S., R.A.L., J.A.)
| | - Wendy Whiteside
- Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, OH (B.H.G., W.W., W.J.W., C.M.M.)
| | - W. Jack Wallen
- Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, OH (B.H.G., W.W., W.J.W., C.M.M.)
| | - Christina M. Metcalf
- Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, OH (B.H.G., W.W., W.J.W., C.M.M.)
| | - Varun Aggarwal
- Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston (V.A., H.A., A.M.Q.)
| | - Hitesh Agrawal
- Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston (V.A., H.A., A.M.Q.)
| | - Athar M. Qureshi
- Lillie Frank Abercrombie Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston (V.A., H.A., A.M.Q.)
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20
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Garg G, Mittal DK. Stenting of patent ductus arteriosus in low birth weight newborns less than 2kg- procedural safety, feasibility and results in a retrospective study. Indian Heart J 2018; 70:709-712. [PMID: 30392511 PMCID: PMC6204448 DOI: 10.1016/j.ihj.2018.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 12/03/2022] Open
Abstract
Objective Retrospective analysis of the feasibility, safety and results of patent ductus arteriosus (PDA) stenting in low birth weight babies weighing < 2 kg. Background: Stenting of patent ductus arteriosus is a well known palliative technique for several years as an alternative to shunt surgery in babies weighing > 2.5–3 kg. Ductal stenting in babies weighing less than 2 kg is not done routinely all around the world due to limited experience and concerns regarding its feasibility and safety in such small subset. Methods Records of patients who underwent PDA stenting at our institution from June 2014 to December 2016 were reviewed. In this period, we attempted to do PDA stenting using femoral artery approach in babies weighing < 2 kg. Echocardiography and colour Doppler were used for patient selection and assessment of procedural outcome. Results PDA stenting using femoral artery approach was successful in all 5 patients weighing < 2 kg. In this group, patient age ranged from 2 days to 16 days and weighed 1.8 kg to 1.97 kg. All patients had good post-procedure outcome. One patient had stent malposition from aortic end towards main pulmonary artery which was managed by an additional stent. Conclusion PDA stenting is feasible and safe with good end results in carefully selected low birth weight babies weighing < 2 kg.
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Affiliation(s)
- Gaurav Garg
- Department of Pediatric Cardiology, Max Superspeciality Hospital, Shalimar Bagh, New Delhi, India.
| | - Dinesh Kumar Mittal
- Department of Cardiac Surgery, Max Superspeciality Hospital, Shalimar Bagh, New Delhi, India
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21
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Kim MS, Yoon JK, Kim SH, Bang JS, Jang SI, Lee SY, Choi EY, Park SJ, Kwon HW. The outcome of percutaneous stent implantation in congenital heart disease: experience of a single institute. KOREAN JOURNAL OF PEDIATRICS 2018; 61:187-193. [PMID: 29963102 PMCID: PMC6021364 DOI: 10.3345/kjp.2018.61.6.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/17/2017] [Accepted: 10/27/2017] [Indexed: 11/27/2022]
Abstract
Purpose The efficacy of percutaneous stent implantation for congenital heart disease (CHD) in Korea, where stent availability is limited, has not been determined. This study evaluated the acute and midterm results of stent implantation in different CHD subgroups. Methods Stents were implanted in 75 patients with 81 lesions: (1) pulmonary artery stenosis (PAS) group, 56 lesions in 51 patients; (2) coarctation of the aorta (CoA) group, 5 lesions in 5 patients; (3) Fontan group, 13 lesions in 12 patients; (4) ductal stent group, 3 lesions in 3 patients; and (5) other CHD group, 4 lesions in 4 patients. Mean follow-up duration was 2.1 years (0.1–4 years). Medical records were reviewed retrospectively. Results The minimum lumen diameter (MLD) in PAS and CoA increased from 5.0±1.9 mm and 8.4±1.6 mm to 10.1±3.6 mm and 12.3±2.5 mm, respectively (P<0.01). In the PAS group, pressure gradient decreased from 25.7±15.6 mmHg to 10.4±10.1 mmHg, and right ventricular to aortic pressure ratio from 0.56±0.21 to 0.46±0.19. In the CoA group, the pressure gradient decreased from 50±33 mmHg to 17±8 mmHg. In the ductal stent group, the MLD of the ductus increased from 2.3 mm to 4.3 mm and arterial oxygen saturation from 40%–70% to 90%. No deaths were associated with stent implantation. Stent migration occurred in 3 patients, but repositioning was successful in all. Stent redilation was performed successfully in 26 cases after 29±12 months. Conclusion Percutaneous stent implantation was safe and effective, with acceptable short and mid-term outcomes in Korean CHD patients.
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Affiliation(s)
- Moon Sun Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Ja Kyoung Yoon
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Seong Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Ji Seok Bang
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - So Ick Jang
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Sang Yoon Lee
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Eun Young Choi
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Su Jin Park
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Hye Won Kwon
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
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22
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Polat TB. Stenting the vertical ductus arteriosus via axillary artery access using “wire-target” technique. CONGENIT HEART DIS 2017; 12:800-807. [DOI: 10.1111/chd.12512] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 06/06/2017] [Accepted: 06/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Tugcin Bora Polat
- Department of Pediatric Cardiology; Kemerburgaz University School of Medicine; Istanbul Turkey
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23
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Thakkar B, Raval A, Madan T, Oswal N, Umalkar R, Shah K, Maheriya B. Transvenous arterial duct stenting in cyanotic patients with pulmonary atresia and ventricular septal defect. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Celebi A, Yucel IK, Bulut MO, Kucuk M, Balli S. Stenting of the ductus arteriosus in infants with functionally univentricular heart disease and ductal-dependent pulmonary blood flow: A single-center experience. Catheter Cardiovasc Interv 2016; 89:699-708. [DOI: 10.1002/ccd.26796] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 08/20/2016] [Accepted: 08/26/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Ahmet Celebi
- Department of Pediatric Cardiology; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital; Istanbul Turkey
| | - Ilker Kemal Yucel
- Department of Pediatric Cardiology; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital; Istanbul Turkey
| | - Mustafa Orhan Bulut
- Department of Pediatric Cardiology; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital; Istanbul Turkey
| | - Mehmet Kucuk
- Department of Pediatric Cardiology; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital; Istanbul Turkey
| | - Sevket Balli
- Department of Pediatric Cardiology; Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital; Istanbul Turkey
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Raval A, Thakkar B, Madan T, Oswal N, Garg R, Umalkar R, Shah K, Maheriya B. Ductus arteriosus stenting: A promising percutaneous palliation in patients with duct-dependent pulmonary circulation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Raval A, Thakkar B, Madan T, Oswal N, Garg R, Umalkar R, Shah K, Maheriya B. Ductus arteriosus stenting: A promising percutaneous palliation in patients with duct-dependent pulmonary circulation. Rev Port Cardiol 2016; 35:583-592. [PMID: 27746039 DOI: 10.1016/j.repc.2016.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/25/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We aimed to study the feasibility and outcomes of ductal stenting in patients with duct-dependent pulmonary blood flow (PBF). METHODS Duct-dependent hypoxic patients with confluent pulmonary artery (PA) branches were enrolled for ductal stenting and followed regularly. RESULTS Sixty patients, with a median age of 12 (1-1095) days and weight of 2.8 (2.2-8.9) kg, were enrolled. Median right PA (RPA) and left PA (LPA) Z-scores were -1.23 (-10.54 to 2.81) and -0.96 (-8.03 to 3.0), respectively. Mean narrowest ductal diameter was 1.73±0.57 mm and length was 12.78±3.32 mm. Sixty-four stents with mean diameter of 4.21±0.32 mm and length of 14.34±3.44 mm were deployed in 59 patients. The procedure was unsuccessful in one. Post-stenting mean oxygen saturation (SO2) increased significantly from baseline of 68.88±7.47% to 90.43±6.04% (p<0001). Complications included pulmonary edema in one patient and acute stent occlusion in another. At a median follow-up of eight (2-14) months, mean SO2 (80.04±7.54%) was significantly higher than baseline (p<0.0001). Median RPA and LPA Z-scores, 0.56 (-2.89 to 3.29) and -0.02 (-2.81 to 3.86), respectively, were significantly higher than baseline. Six patients required re-interventions (shunt in three and angioplasty in three). Six patients died, three due to sepsis and another three with worsened cyanosis due to impaired PBF, probably due to ductal occlusion. CONCLUSION Ductal stenting is an effective palliation in patients with duct-dependent PBF. It maintains adequate SO2 and promotes balanced PA growth at mid-term follow-up.
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Affiliation(s)
- Abhishek Raval
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India.
| | - Bhavesh Thakkar
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India
| | - Tarun Madan
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India
| | - Nilesh Oswal
- Paediatric Cardiology and Cardiothoracic Department, Royal Brompton and Harefield Hospital Foundation NHS Trust, London, United Kingdom
| | - Rajiv Garg
- Delhi Heart Institute and Multispeciality Hospital, Bathinda, India
| | - Rhshikesh Umalkar
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India
| | - Komal Shah
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India
| | - Bhumika Maheriya
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India
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Intervention in Patients with Critical Pulmonary Stenosis in the Ductal Stenting Era. Pediatr Cardiol 2016; 37:1037-45. [PMID: 27033245 DOI: 10.1007/s00246-016-1386-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Abstract
We aimed to assess early and midterm outcomes of balloon valvuloplasty (BVP) procedure in patients with critical pulmonary stenosis (CPS) and to describe the predictors of the need for additional pulmonary flow and reintervention in this subgroup of patients. From 2005 to 2014, 56 neonates were diagnosed with CPS and were included in this study. All echocardiographic, catheterization and angiographic data obtained prior to the initial BVP and at follow-up were reviewed. BVP was successful in 55 neonates (98 %). Twenty-one neonates needed pulmonary blood flow augmentation after BVP (38 %). Ductal stenting (DS) was performed in 20. The patients' mean tricuspid valve (TV) annulus diameter was 10.4 ± 2 mm, and the Z score was -1.29 ± 1 (-3.7 to 0.78). The mean pulmonary valve (PV) annulus diameter was 6 ± 0.9 mm, and the Z score was -1.74 ± 1 (-4.34 to 0.05). A transcatheter or surgical reintervention was performed in 11 patients. A TV Z score < -1.93 SD predicted the need for pulmonary blood flow augmentation after a successful BVP, with a sensitivity of 63.2% and a specificity of 84.4%. A PV Z score < -1.69 SD predicted the need for pulmonary flow augmentation, with a sensitivity of 74 %. The presence of bipartite RV was found to be a significant predictor of the need for reintervention (odds ratio 9.6). Our study showed the excellent immediate outcomes of BPV and DS in a pure cohort of patients with CPS. Prophylactic DS in selected cases seems reasonable and safe.
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Santoro G, Capozzi G, Capogrosso C, Mahmoud HT, Gaio G, Palladino MT, Russo MG. Pulmonary artery growth after arterial duct stenting in completely duct-dependent pulmonary circulation. Heart 2016; 102:459-64. [PMID: 26830664 DOI: 10.1136/heartjnl-2015-308493] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/15/2015] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Significant and balanced pulmonary artery (PA) growth following arterial duct (AD) stenting has already been reported in literature. However, no data are so far available about the role of this percutaneous approach in promoting PA growth in the case of congenital heart disease (CHD) with completely duct-dependent pulmonary blood flow (CDD-PBF). Aim of this study was to evaluate the effect of AD stenting in this pathophysiological setting. METHODS PA growth was evaluated as Nakata index and McGoon ratio as well as individual PA z-score changes in 49 patients submitted to neonatal AD stenting according to their pathophysiology (CDD-PBF (n=15) versus multiple PBF sources (n=34)). RESULTS Control angiography was performed 7.2±6.4 months (range 1-8, median 6) after AD stenting. In the whole population, significant and balanced PA growth was recorded (Nakata index+122±117%; left pulmonary artery (LPA) z-score +84±52%; right pulmonary artery (RPA) z-score +92±53% versus preprocedure, p<0.0001 for all comparisons). Percentage increase of global and branch vessel size was not significantly different in patients with CDD-PBF compared with those with multiple PBF sources (Nakata index 89±90% vs 144±124%; LPA z-score 63±40% vs 89±58%; RPA z-score 74±35% vs 100±57%, p=NS for all comparisons) as was final absolute PA size (Nakata index 237±90 vs 289±80 mm(2)/m(2), p=NS). CONCLUSIONS Percutaneous AD stenting was associated with significant and balanced PA growth in CHD with completely duct-dependent pulmonary circulation over a short-term follow-up. Thus, it may be considered as an alternative to surgical palliation in this subset of patients.
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Affiliation(s)
- Giuseppe Santoro
- Department of Paediatric Cardiology, A.O.R.N. 'Ospedali dei Colli', 2nd University of Naples, Naples, Italy
| | - Giovanbattista Capozzi
- Department of Paediatric Cardiology, A.O.R.N. 'Ospedali dei Colli', 2nd University of Naples, Naples, Italy
| | - Cristina Capogrosso
- Department of Paediatric Cardiology, A.O.R.N. 'Ospedali dei Colli', 2nd University of Naples, Naples, Italy
| | - Heba Talat Mahmoud
- Department of Paediatric Cardiology, A.O.R.N. 'Ospedali dei Colli', 2nd University of Naples, Naples, Italy
| | - Gianpiero Gaio
- Department of Paediatric Cardiology, A.O.R.N. 'Ospedali dei Colli', 2nd University of Naples, Naples, Italy
| | - Maria Teresa Palladino
- Department of Paediatric Cardiology, A.O.R.N. 'Ospedali dei Colli', 2nd University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Department of Paediatric Cardiology, A.O.R.N. 'Ospedali dei Colli', 2nd University of Naples, Naples, Italy
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Santoro G, Gaio G, Capozzi G, Giugno L, Palladino MT, Capogrosso C, D'Aiello AF, Caianiello G, Russo MG. Fate of Hypoplastic Pulmonary Arteries After Arterial Duct Stenting in Congenital Heart Disease With Duct-Dependent Pulmonary Circulation. JACC Cardiovasc Interv 2015; 8:1626-32. [PMID: 26386761 DOI: 10.1016/j.jcin.2015.05.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/05/2015] [Accepted: 05/22/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study sought to evaluate the impact of arterial duct (AD) stenting in promoting catch-up growth of hypoplastic pulmonary artery (PA) tree in congenital heart disease with duct-dependent pulmonary circulation (CHD-DPC). BACKGROUND Significant and balanced PA growth following AD stenting has already been consistently reported in the literature. However, no data are so far available about the role of this approach in severe PA hypoplasia, which significantly impacts the risk of surgical repair. METHODS Pre-surgical angiographic PA evaluation was performed in 45 patients with confluent PAs submitted to neonatal AD stenting as palliation of CHD-DPC. PA growth was evaluated as Nakata Index and McGoon ratio as well as individual PA z-score changes, both in the whole population and according to the original vessel size (Nakata Index <100 mm(2)/m(2), Group I [n = 15] vs. Nakata Index >100 mm(2)/m(2), Group II [n = 30]). RESULTS Control angiography was performed 7.5 ± 6.5 months (median 6 months) after duct stenting, showing significant and balanced PA growth. The Nakata Index increased from 143 ± 73 mm(2)/m(2) to 270 ± 88 mm(2)/m(2) (124 ± 118%, p < 0.0001); left PA z-score from -0.7 ± 1.7 to 1.0 ± 1.4; right PA z-score from -0.6 ± 1.3 to 1.2 ± 1.3 (p < 0.0001 for both comparisons). Group I showed a greater increase of global PA growth (Nakata Index increase 227 ± 141% vs. 72 ± 57%, p < 0.001) as compared with Group II. Final PA size did not significantly differ between the groups (246 ± 105 mm(2)/m(2) vs. 282 ± 78 mm(2)/m(2), p = NS). CONCLUSIONS Percutaneous AD stenting is highly effective in promoting a significant and balanced catch-up growth of diminutive PAs, being therefore advisable in this subset of patients as a reliable alternative to surgical palliation.
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Affiliation(s)
- Giuseppe Santoro
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy.
| | - Gianpiero Gaio
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Giovanbattista Capozzi
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Luca Giugno
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Maria Teresa Palladino
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Cristina Capogrosso
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Angelo Fabio D'Aiello
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Giuseppe Caianiello
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology and Paediatric Cardiac Surgery, A.O.R.N. "Ospedali dei Colli," 2nd University of Naples, Naples, Italy
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Santoro G, Gaio G, Giugno L, Capogrosso C, Palladino MT, Iacono C, Caianiello G, Russo MG. Ten-years, single-center experience with arterial duct stenting in duct-dependent pulmonary circulation: Early results, learning-curve changes, and mid-term outcome. Catheter Cardiovasc Interv 2015; 86:249-57. [DOI: 10.1002/ccd.25949] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 03/15/2015] [Indexed: 12/17/2022]
Affiliation(s)
- Giuseppe Santoro
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Gianpiero Gaio
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Luca Giugno
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Cristina Capogrosso
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Maria Teresa Palladino
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Carola Iacono
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Giuseppe Caianiello
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology and Cardiac Surgery; a.O.R.N. “Ospedali Dei Colli”; 2nd University of Naples Naples Italy
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Implantación de stent en neonatos y lactantes menores con cardiopatía congénita cianosante ductus dependiente. REVISTA COLOMBIANA DE CARDIOLOGÍA 2014. [DOI: 10.1016/s0120-5633(14)70266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Garg G, Srivastava A, Radha AS. Simultaneous stenting of tightly stenosed patent ductus arteriosus and pulmonary artery bifurcation using two stents (Y stenting): An innovative technique. Catheter Cardiovasc Interv 2014; 83:1131-4. [DOI: 10.1002/ccd.25413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/23/2013] [Accepted: 01/25/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Gaurav Garg
- Department of Pediatric Cardiology; Apollo Health City; Jubilee Hills Hyderabad India
| | - Anurakti Srivastava
- Department of Pediatric Cardiology; Apollo Health City; Jubilee Hills Hyderabad India
| | - Anil Sivadasan Radha
- Department of Pediatric Cardiology; Apollo Health City; Jubilee Hills Hyderabad India
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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.
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Affiliation(s)
- Shakeel Ahmed Qureshi
- Department of Pediatric Cardiology, Guy's Hospital, 11th Floor Guy's Tower, St Thomas Street, London SE1 9RT, UK.
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Abstract
Ductal stenting in neonates with either duct-dependent pulmonary or systemic circulation has become a good alternative for the initial palliation of complex congenital heart disease. Changes of stent and catheter technology (low profile, flexible, premounted stents with good scaffolding), better patient selection and preparation, optimal interventional access and covering the complete length of the duct have significantly improved results.
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Schranz D, Michel-Behnke I. Advances in interventional and hybrid therapy in neonatal congenital heart disease. Semin Fetal Neonatal Med 2013; 18:311-21. [PMID: 23759171 DOI: 10.1016/j.siny.2013.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In addition to the considerable surgical advances in treating congenital heart diseases, hybrid and transcatheter therapies have become a cornerstone of neonatal cardiology within the last decade. Approaches to the care of cyanotic newborns with congenital heart disease focused on manipulations of the inter-atrial septum, right ventricular outflow tract obstructions, and on the arterial duct as the source for pulmonary blood flow. Currently, fewer interventional procedures are used in newborns and small infants to treat excessive pulmonary blood flow caused by shunt lesions, but transcatheter techniques and hybrid strategies have been developed to treat newborns suffering from inadequate systemic perfusion. However, transcatheter techniques are still not available to treat failing systemic ventricles without obvious structural disorders of the myocardium or dilated cardiomyopathies in newborns and infancy, despite new surgical-interventional strategies are already developed to avoid or to delay early heart transplantation. In conclusion, material and technical improvements have enabled transcatheter techniques to replace medical-based therapies to solve structurally dependent cardiovascular diseases. However, evidence-based and long-term follow-up data are required.
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Affiliation(s)
- Dietmar Schranz
- Department of Pediatric Cardiology, Pediatric Heart Center, Justus-Liebig-University Giessen, Germany.
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Matter M, Almarsafawey H, Hafez M, Attia G, Abuelkheir MM. Patent ductus arteriosus stenting in complex congenital heart disease: early and midterm results for a single-center experience at children hospital, Mansoura, Egypt. Pediatr Cardiol 2013; 34:1100-6. [PMID: 23239311 DOI: 10.1007/s00246-012-0608-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
Abstract
This study aimed to assess the efficacy and outcome of transcatheter ductus arteriosus stenting in newborns and infants with ductal-dependent or decreased pulmonary circulation. Between September 2009 and December 2011, 33 newborns and infants were subjected to patent ductus arteriosus (PDA) stenting as an alternative to a surgical shunt. Of the 33 patients, 20 had pulmonary atresia (PA) with a ventricular septal defect, 4 had PA with an intact ventricular septum, 5 had PA with a double-outlet right ventricle, and 4 had critical pulmonary stenosis. The McGoon ratio ranged from 0.8 to 1.9 (median 1.27). The ages of the patients ranged from 3 to 56 days, and their weight ranged from 2.7 to 4.1 kg. The oxygen saturation ranged from 45 to 61 %, and the pH ranged from 7.13 to 7.27. Premounted coronary stents with diameters of 3, 3.5, and 4 mm were used to cover the whole length of the ductus. The PDA was tortuous in 23 patients and straight in 10 patients. The mean ductal length was 12.2 ± 3.7 mm (range 7.8-23 mm). The mean stent length was 14.3 ± 3.4 mm (range, 8-23 mm), and the mean narrowest ductal diameter was 1.9 ± 0.6 mm (range, 0.8-2.9 mm). Immediately after the procedure, the oxygen saturation was increased from a mean of 75.1 ± 13.2-91.5 ± 6.3 % (p < 0.0001), and the PDA diameter was increased from a mean of 1.9 ± 0.6-4.3 ± 0.8 mm (p < 0.0001). Stent redilation was necessary in two patients 8 days after the procedure, and their oxygen saturation increased 79-88 %. The mean fluoroscopy time was 39.4 ± 15.5 min. Stent dislocation to the left main pulmonary artery was seen in one patient, with another stent placed in the arterial duct. No procedure-related mortality occurred. Two neonates died a few days after the procedure due to sepsis related to the procedure. The surviving patients were discharged home 8-30 days (median, 9.5 days) after the procedure. Stent patency was achieved for 8-550 days. The McGoon ratio increased and ranged from 1.6 to 2.8 (median, 1.87) before the surgical intervention. Glenn anastomosis was possible for 18 patients at the age of 6-8 months. Nine patients experienced worsening of cyanosis about 4 months after stent placemen. Six of these patients required a Blalock-Taussig shunt, whereas stent dilation was possible for the remaining three patients. Four patients died of severe dehydration while awaiting a Glenn shunt. The findings show that PDA stenting can be a good alternative to surgery for initial palliation, especially in infants who will need multiple surgeries. It is safe and feasible but its efficacy gradually lessens after 6 months due to intrastent endothelial hyperplasia.
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Affiliation(s)
- Mohamed Matter
- Pediatric Cardiology Unit, Mansoura University Children's Hospital, Mansoura 35516, Egypt.
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Cho MJ, Ban KH, Kim MJ, Park JA, Lee HD. Catheter-based treatment in patients with critical pulmonary stenosis or pulmonary atresia with intact ventricular septum: a single institute experience with comparison between patients with and without additional procedure for pulmonary flow. CONGENIT HEART DIS 2013; 8:440-9. [PMID: 23602004 DOI: 10.1111/chd.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We report a single institute experience of transcatheter pulmonary valvotomy using the soft end of a guidewire followed or not by a systemic-pulmonary shunt in patients with pulmonary atresia with intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS). In addition, we compare patients with or without an additional source of flow to support the pulmonary circulation after successful pulmonary valvotomy. METHODS All neonates with PAIVS or CPS who underwent primary transcatheter pulmonary valvotomy between January 2004 and December 2010 were reviewed retrospectively. Some of them needed an additional source of flow to support the pulmonary circulation. We performed a comparison between those who required an additional source of pulmonary flow and those who did not. RESULTS The initial procedure was successful in 20 out of 22 patients (seven of nine with PAIVS; all of 13 with CPS), but 10 of them needed an additional source of flow to support the pulmonary circulation: nine had arterial duct stenting and one had surgical Blalock-Taussig shunt. There were no deaths or major acute complications, except for femoral artery occlusion in three patients. The bipartite right ventricular morphology, the tricuspid z-score of ≤-0.74, the tricuspid to mitral valve ratio of ≤ 0.9, and the z-score of the diastolic interventricular septal thickness ≥ 2.37 in preprocedural examination showed more tendency of needing shunt placement. CONCLUSION Transcatheter pulmonary valvotomy using the soft end of a guidewire followed or not by the arterial duct stent implantation was an effective approach in those patients. The angiographic distinction between CPS and PAIVS did not affect anything in this study including the procedural method, success, and odds for reintervention. The degree of right ventricle cavity hypoplasia provided the main restriction to forward flow after pulmonary valvotomy.
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Affiliation(s)
- Min-Jung Cho
- Pediatrics, Medical Research Institute of Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
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Udink ten Cate FE, Sreeram N, Hamza H, Agha H, Rosenthal E, Qureshi SA. Stenting the arterial duct in neonates and infants with congenital heart disease and duct-dependent pulmonary blood flow: A multicenter experience of an evolving therapy over 18 years. Catheter Cardiovasc Interv 2013; 82:E233-43. [DOI: 10.1002/ccd.24878] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/25/2013] [Accepted: 02/11/2013] [Indexed: 12/14/2022]
Affiliation(s)
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, Heart Center; University Hospital of Cologne; Cologne; Germany
| | - Hala Hamza
- Department of Pediatric Cardiology; Cairo University Children Hospital; Cairo; Egypt
| | - Hala Agha
- Department of Pediatric Cardiology; Cairo University Children Hospital; Cairo; Egypt
| | - Eric Rosenthal
- Department of Congenital Heart Disease; Evelina Children's Hospital, Guy's and St. Thomas' Hospital London; United Kingdom
| | - Shakeel A. Qureshi
- Department of Congenital Heart Disease; Evelina Children's Hospital, Guy's and St. Thomas' Hospital London; United Kingdom
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Reappraisal of the prostaglandin E1 dose for early newborns with patent ductus arteriosus-dependent pulmonary circulation. Pediatr Neonatol 2013; 54:102-6. [PMID: 23590954 DOI: 10.1016/j.pedneo.2012.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/24/2011] [Accepted: 10/03/2012] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The usual initial dose of prostaglandin E1 (PGE1) for ductal-dependent congenital heart disease (CHD) is 50-100 ng/kg/minute. The aim of this study was to review our experience of a low initial dose of PGE1 treatment in early newborns with congenital heart disease and patent ductus arteriosus (PDA)-dependent pulmonary flow. METHODS We reviewed the clinical data of 33 newborns with CHD and PDA-dependent pulmonary circulation who were admitted from January 2005 to December 2010. Clinical parameters were collected, including, PGE1 dosage, oxygenation condition, vital signs, and other related clinical parameters during admission. Echocardiography was employed to assess the status of the PDA as clinically indicated. RESULTS Thirty-three newborns, including 17 males and 16 females, with CHD and PDA-dependent pulmonary circulation were enrolled in the study. Their mean age was 2.9 ± 5.1 (within the range of 1-26) days with a median of 1.0 day. Among the 33 cases, 25 were diagnosed with pulmonary atresia and eight with critical pulmonary stenosis. Twenty-five of our patients were treated with the initial low-dosage regimen of 20.0 ± 7.4 ng/kg/minute in our neonatal intensive care unit. None of these 25 patients with had significant apnea necessitating intubation and none had hypotension, fever, convulsion or cortical hyperostosis. Three of the eight patients who were treated with high-dose PGE1 (39 ± 13.2 ng/kg/minute) before referral to our unit had apnea and intubation after PGE1 use. All patients had adequate PDA patency with a low maintenance dose of 10.5 ± 5.3 ng/kg/minute before operation under our protocol. CONCLUSION In our experience, adequate PDA flows in early newborns with CHD and PDA-dependent pulmonary circulation could be achieved at a much lower dose than recommended in the literature. The lower dose of PGE1 also causes much fewer complications, such as apnea, fever, and hypotension. For early newborns with CHD and PDA-dependent pulmonary circulation, treatment with a lower initial dose of PGE1 of 20 ng/kg/minute and a maintenance dose of 10 ng/kg/minute is recommended.
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Alwi M, Mood MC. Stenting of Lesions in Patent Ductus Arteriosus with Duct-Dependent Pulmonary Blood Flow: Focus on Case Selection, Techniques and Outcome. Interv Cardiol Clin 2012; 2:93-113. [PMID: 28581990 DOI: 10.1016/j.iccl.2012.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Stenting of patent ductus arteriosus (PDA) is an attractive alternative to the surgical aortopulmonary shunt in the palliation of cyanotic congenital heart disease. However, the diverse morphology of PDA in this setting limits its role, as stenting an overly tortuous duct may not be feasible, and in a significant number of patients, ductus-related pulmonary artery stenosis contraindicates this procedure. The major acute complications are stent migration, thrombosis, and cardiac failure. Early failure of palliation caused by in-stent stenosis is another limitation of this procedure.
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Affiliation(s)
- Mazeni Alwi
- Department of Paediatric Cardiology, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, Kuala Lumpur 50400, Malaysia.
| | - Marhisham Che Mood
- Department of Paediatric Cardiology, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, Kuala Lumpur 50400, Malaysia
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Short-term result of ductus arteriosus stent implantation compared with surgically created shunts. Pediatr Cardiol 2012; 33:1288-94. [PMID: 22447384 DOI: 10.1007/s00246-012-0304-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 03/13/2012] [Indexed: 10/28/2022]
Abstract
This report aims to compare the researchers' early experience with the safety, efficacy, short-term outcomes, and complications of patent ductus arteriosus (PDA) stents in neonates having duct-dependent pulmonary circulation with those of surgically created shunts. Between April 2009 and April 2011, 18 infants with duct-dependent pulmonary circulation underwent cardiac catheterization for PDA stenting as the first palliative procedure in a referral center. For comparison, 20 infants who underwent surgical aortopulmonary shunt placement in another center were used. Follow-up assessment included clinical examination, echocardiography, oxygen saturation, and cardiac catheterization studies. Access and stenting for the PDA were successful in 15 patients (83.3 %). The mean procedure time was 58.43 ± 41.25 min, and the mean fluoroscopy time was 18.81 ± 5.64 min. Three patients (20 %) in the stented group and 6 patients (30 %) in the surgical group died (P = 0.09). After a 6-month follow-up period, none of the patients had significant stent stenosis requiring reintervention. The oxygen saturation increase did not differ significantly between the two groups either immediately after the procedure or 6 months later (P > 0.5). The left pulmonary artery diameter, McGoon ratio, and Nakata index did not differ significantly between the two groups (P > 0.05), but the right pulmonary diameter was larger in the stented group (5.01 ± 0.45 vs 4.1 ± 0.49 mm; P = 0.0001). Stenting for the PDA is an appropriate alternative to surgical shunt creation in many patients with duct-dependent circulation. In our sample, the two groups did not differ significantly in terms of outcome or mortality.
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Alwi M. Stenting the patent ductus arteriosus in duct-dependent pulmonary circulation: techniques, complications and follow-up issues. Future Cardiol 2012; 8:237-50. [PMID: 22413983 DOI: 10.2217/fca.12.4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Maintaining ductal patency in duct-dependent congenital heart lesions by implantation of coronary stents is an alternative to systemic pulmonary shunt in selected cases and lesions with suitable anatomy. This article focuses on the procedure as the initial palliation in duct-dependent pulmonary circulation, its associated pitfalls and complications. A good understanding of the diverse duct morphology is paramount prior to stenting of the ductus. Long tortuous duct, insufficiently constricted ductus at the pulmonary end and ductus with associated branch pulmonary artery stenosis at the site of insertion are not suitable for stenting. Durability of palliation is generally inferior to a surgical shunt and this may dictate earlier definitive surgical repair. Acceleration of branch pulmonary artery stenosis in certain ductal morphology limits its general applicability. Bioabsorbable and biodegradable stents may offer some solution to this problem.
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Affiliation(s)
- Mazeni Alwi
- Department of Pediatric Cardiology, Institut Jantung Negara (National Heart Institute), 50400 Kuala Lumpur, Malaysia.
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Sivakumar K, Bhagyavathy A, Coelho R, Satish R, Krishnan P. Longevity of neonatal ductal stenting for congenital heart diseases with duct-dependent pulmonary circulation. CONGENIT HEART DIS 2012; 7:526-33. [PMID: 22548982 DOI: 10.1111/j.1747-0803.2012.00657.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Ductal stent (DS) in duct-dependent pulmonary circulation is less morbid than neonatal Blalock-Taussig shunt. However, there is concern if DS provides an adequately long palliation before definitive repair. METHODS This is a retrospective review of clinical follow-up of all consecutive infants after successful DS performed by a single operator. They were divided into three anatomic groups. Group A neonates had balloon valvotomy for critical pulmonary stenosis or pulmonary atresia with intact ventricular septum, who needed DS patency until the right ventricle was adequate to provide antegrade pulmonary flows. Group B patients with tetralogy of Fallot and pulmonary atresia suited for later biventricular repair needed ductal patency until conduit surgery was completed. Group C patients with functionally univentricular hearts needed DS patency until bidirectional Glenn shunt completion. RESULTS Among 22 infants, four Group A patients followed for 26-54 months after balloon pulmonary valvotomy had adequate oxygen saturation and needed only short-term DS patency. In six out of nine Group B patients, corrective biventricular repair using conduits was performed after 5-14 months at a body weight of 5-7.5 kg. Bidirectional Glenn shunt and confluence repair were performed in seven of nine Group C patients weighing 6-8.5 kg after 8-15 months. The hilar pulmonary artery growth in B and C groups was adequate for surgical repair. No patient needed stent redilatations or additional shunts on follow-up for hypoxia. Four patients had sudden death. CONCLUSIONS The short-term patency of DS was adequate after balloon valvotomy for critical pulmonary stenosis or pulmonary atresia with intact ventricular septum. Duration of palliation by DS was also sufficient in univentricular hearts to allow adequate somatic growth before Glenn surgery. In patients with biventricular anatomy treated by DS, conduit repair had to be performed at a relatively early age. Interstage mortality was 18%.
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Schranz D, Michel-Behnke I, Heyer R, Vogel M, Bauer J, Valeske K, Akintürk H, Jux C. Stent implantation of the arterial duct in newborns with a truly duct-dependent pulmonary circulation: a single-center experience with emphasis on aspects of the interventional technique. J Interv Cardiol 2011; 23:581-8. [PMID: 20642476 DOI: 10.1111/j.1540-8183.2010.00576.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Ductal stenting for pulmonary blood supply in newborns with cyanotic congenital heart disease (CHD) might be a low risk and safe alternative to the surgical aorto-to-pulmonary artery (AP) shunt in dual-source lung perfusion. Ductal stenting in truly duct-dependent pulmonary circulation has not been evaluated. METHODS Prospective interventional and clinical follow-up trial. Ductal stenting based on variable access sites, a 2-wire technique when crossing a tortuous ductus, and use of premounted coronary stents. Primary outcome measures were procedural success and complication rates presented as early and mid-term results. RESULTS From 2003-2009, 58 duct-dependent newborns underwent ductal stenting; 27 of them were truly duct dependent, 20 had pulmonary atresia (PA)/ventricular septum defect or complex CHD, 4 had PA/intact ventricular septum, 2 had PA with Ebstein anomaly, and 1 had PA with tricuspid atresia. Ductal stenting was performed without procedure-related mortality; 3 of 27 required an acute surgical AP-shunt (stent migration in 1, acute duct obstruction in 2). During mid-term follow-up, 4 of 24 needed an AP-shunt and two others stent redilation. Three patients died prior to follow-up surgery (1 unexpectedly at home and 2 due to syndromatic disease). Fifteen patients received staged univentricular palliation, 8 had a biventricular repair, and 1 is awaiting follow-up operation. CONCLUSION Ductal stenting is a feasible, safe, and effective palliation in newborns with truly duct-dependent pulmonary circulation irrespective of duct morphology. Vasucular access from various locations is important for technical success rate. Ductal stenting is a minimally invasive procedure to achieve adequate pulmonary artery growth for subsequent palliative or corrective surgery.
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Affiliation(s)
- Dietmar Schranz
- Department of Paediatric Cardiology and Cardiac Surgery, Pediatric Heart Center, Justus-Liebig-University Giessen, Germany.
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Abstract
Ductal stenting is an attractive alternative to conventional shunt surgery in duct dependent congenital heart disease as it avoids thoracotomy and its related problems. With today's generation of coronary stents which have better profile, flexibility and trackability, ductal stenting may be achieved safely and with considerably less difficulty than previously described.As in Blalock-Taussig (BT) shunt, ductal stenting is indicated mainly in duct-dependent cyanotic lesions chiefly in the neonatal period. Unlike the Patent ductus arteriosus (PDA) as an isolated lesion, the ductus in cyanotic heart disease has a remarkable morphologic variability. The ductus tends to arise more proximally under the aortic arch, giving rise to a vertical ductus or occasionally it may arise from the subclavian artery. It also tends to be long and sometimes very tortuous, rendering stent implantation technically impossible. The ductus in these patients may also insert onto one of the branch pulmonary arteries with some stenosis at the site of insertion. The ductus in Tetralogy of Fallot with pulmonary atresia (TOF-PA) tend to exhibit these morphologic features and to a lesser degree in transposition of great arteries with ventricular septal defect and pulmonary atresia (TGA-VSD-PA) and the more complex forms of univentricular hearts. In the preliminary angiographic evaluation, it is important to delineate these morphologic features as the basis for case selection.Ductal stenting may be done by the retrograde femoral artery route or the antegrade transvenous route depending on the ductus morphology and the underlying cardiac lesion. The detailed techniques and essential hardware are described. Finally, major potential complications of the procedure are described. Acute stent thrombosis is the most serious and potentially catastrophic. Emergent treatment with thrombolytic therapy and mechanical disruption of thrombus are required. With proper case selection, appropriate technique and the right hardware ductal stenting provides reasonable short-medium term palliation in duct-dependent cyanotic heart disease.
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Affiliation(s)
- Mazeni Alwi
- Department of Paediatric Cardiology, Institut Jantung Negara (National Heart Institute), Jalan Tun Razak, Kuala Lumpur, Malaysia
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Affiliation(s)
- Dietmar Schranz
- Pediatric Heart Center Justus Liebig University, Giessen, Germany
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Alwi M, Choo KK, Radzi NA, Samion H, Pau KK, Hew CC. Concomitant stenting of the patent ductus arteriosus and radiofrequency valvotomy in pulmonary atresia with intact ventricular septum and intermediate right ventricle: Early in-hospital and medium-term outcomes. J Thorac Cardiovasc Surg 2011; 141:1355-61. [DOI: 10.1016/j.jtcvs.2010.08.085] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 08/03/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
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Feltes TF, Bacha E, Beekman RH, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123:2607-52. [PMID: 21536996 DOI: 10.1161/cir.0b013e31821b1f10] [Citation(s) in RCA: 512] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Santoro G, Gaio G, Castaldi B, Palladino MT, Iacono C, Russo MG, Calabrò R. Arterial duct stenting in low-weight newborns with duct-dependent pulmonary circulation. Catheter Cardiovasc Interv 2011; 78:677-85. [PMID: 21538781 DOI: 10.1002/ccd.23076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/20/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate feasibility and results of arterial duct (AD) stenting in low-weight newborns with congenital heart disease and duct-dependent pulmonary circulation (CHD-DPC). BACKGROUND AD stenting is nowadays considered a cost-effective alternative to surgical shunt in CHD-DPC. This option might be even more advisable in low-weight neonates (<2.5 kg), who are at higher surgical risk and in whom stent redilation might adapt shunt magnitude to patient's growth. METHODS Between April 2003 and September 2010, 76 neonates with CHD-DPC underwent AD stenting at our institution, as lower-risk palliation with respect to surgical shunt. Procedural and follow-up data of the 15 low-weight newborns (2.0 ± 0.3 kg, median 2.2) (group I) were compared with the remaining normal-weight newborns (3.5 ± 0.7 kg, median 3.2) (group II). RESULTS Feasibility, complication rate, and need for surgical shunt did not significantly differ between groups. Global X-ray exposure was significantly higher in the low-weight group (82 ± 108 vs. 30 ± 33 Gray/cm(2) , P < 0.002), which maybe due to a longer angiographic presenting work-up. In-hospital mortality rate was 14.3% (vs. 1.9% in the group II, P = NS), although none of the fatalities was procedure-related. During follow-up, five patients (35.7% vs. 15.7% in the group II, P = NS) underwent stent redilation before surgical repair. At control angiography, the Nakata and McGoon indexes had significantly increased (P < 0.05 for both comparisons), without any significant difference with the group II (162 ± 52% vs. 144 ± 158% and 40 ± 17% vs. 42 ± 38%, P = NS). CONCLUSIONS AD stenting is also feasible and effective in low-weight newborns with CHD-DPC, supporting the spontaneous improvement process or promoting a significant pulmonary artery growth.
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Affiliation(s)
- Giuseppe Santoro
- Cardiology, AO Monaldi, 2nd University of Naples, Naples, Italy.
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