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Demir IH, Ozdemir DM, Yucel IK, Yılmaz EH, Bulut MO, Surucu M, Korun O, Aydemir NA, Celebi A. The Lifesaving Impact of Transcatheter Interventions in the Early Post-Fontan Palliation Period. Pediatr Cardiol 2024; 45:986-997. [PMID: 38509208 DOI: 10.1007/s00246-024-03455-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/16/2024] [Indexed: 03/22/2024]
Abstract
Despite advancements in postoperative outcomes after Fontan surgery, there remains a risk of suboptimal outcomes and significant morbidity in the early postoperative period. Anatomical obstructions in the Fontan pathway can lead to prolonged pleural effusion or ascites, cyanosis, and low cardiac output syndrome (LCOS). Transcatheter interventions offer an alternative to early re-surgery for treating these complications. Over a 13-year period, early catheter angiography, performed within 30 days post-index procedure, was administered to 41 patients, identifying anatomical issues that necessitated re-intervention in 39 cases. This led to transcatheter interventions in 37 (10.4%) of the 344 Fontan surgery patients. The median age was 4.8 years (IQR: 4-9.4), and the median weight was 16.5 kg (IQR: 15-25.2), with females comprising 51.4% (19/37) of this group. The primary indications for the procedures were persistent pleural effusion or ascites in 27 patients (66%), LCOS in 8 patients (20%), and cyanosis in 6 patients (14%). Among the 37 undergoing transcatheter intervention, 30 were treated solely with this method and discharged, three died in ICU follow-up, and four required early re-surgery. No procedural mortality was observed. Our findings demonstrate that transcatheter interventions, including stent implantation, balloon angioplasty, and fenestration dilation, are safe and effective in the early post-Fontan period. Therefore, they should be considered an integral part of the management strategy for this patient group.
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Affiliation(s)
- Ibrahim Halil Demir
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No 13 Uskudar, Istanbul, Turkey.
| | - Dursun Muhammed Ozdemir
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No 13 Uskudar, Istanbul, Turkey
| | - Ilker Kemal Yucel
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No 13 Uskudar, Istanbul, Turkey
| | - Emine Hekim Yılmaz
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No 13 Uskudar, Istanbul, Turkey
| | - Mustafa Orhan Bulut
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No 13 Uskudar, Istanbul, Turkey
| | - Murat Surucu
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No 13 Uskudar, Istanbul, Turkey
| | - Oktay Korun
- Department of Pediatric Cardiovascular Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Numan Ali Aydemir
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Celebi
- Department of Pediatric Cardiology, University of Health Sciences Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tıbbiye Street, No 13 Uskudar, Istanbul, Turkey
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Callegari A, Geiger J, Callaghan FM, Kellenberger C, Usemann J, Burkhardt BEU, Kretschmar O, Valsangiacomo Büchel E. Possible effects of left pulmonary artery stenting in single ventricle patients on bronchial area, lung volume and lung function. Front Pediatr 2024; 11:1337568. [PMID: 38293662 PMCID: PMC10825946 DOI: 10.3389/fped.2023.1337568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
Background Left pulmonary artery (LPA) stenting is often required in single ventricle (SV) patients. Due to their close anatomical relationship an LPA stent could potentially compress the left main bronchus (LMB). We assessed the impact of LPA stenting on bronchial size, pulmonary volumes, and lung function in a cohort of SV patients. Methods Forty-nine patients underwent cardiovascular magnetic resonance (CMR) and 36 spirometry 11 (8-15) years after Fontan. All patients were free of respiratory symptoms. LPA stents were inserted in 17 (35%) patients at 8.8 (3.4-12.6) years. Area/shape of the main bronchi (n = 46) and lung volumes (n = 47) were calculated from CMR-ZTE images for each lung and transformed in right-to-left (r/l) ratio and indexed for BSA. The effect of early stent insertion (prior to stage III) was analyzed. Results Patients with LPA stent had larger r/l ratio for main bronchus area (p < 0.001) and r/l ratio difference for lung volumes was slightly larger in patients with early stenting. A trend toward a deformation of LMB shape in patients with LPA stent and toward a higher prevalence of abnormal spirometry in patients with early stent implantation was observed. Conclusions In this cohort of patients, early insertion of LPA stents seems to relate with smaller LMB sizes and a trend toward smaller left lung volume and higher prevalence of impaired lung function. Whether these findings are caused by the stent or, at least to a certain degree, present prior to the implantation needs to be verified.
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Affiliation(s)
- Alessia Callegari
- Pediatric Heart Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Geiger
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Fraser Maurice Callaghan
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for MR-Research, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Christian Kellenberger
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Jakob Usemann
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Division of Respiratory Medicine, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Barbara Elisabeth Ursula Burkhardt
- Pediatric Heart Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Pediatric Heart Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Emanuela Valsangiacomo Büchel
- Pediatric Heart Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
- Division of Respiratory Medicine, University Children’s Hospital Zurich, Zurich, Switzerland
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