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Sasikumar N, Alawani S, Sudhakar A, Kumar RK. Simultaneous Double Balloon Dilatation for Supravalvar Pulmonary Obstruction After Arterial Switch Operation. Pediatr Cardiol 2024; 45:1823-1829. [PMID: 37697169 DOI: 10.1007/s00246-023-03288-6] [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: 02/17/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
The optimal approach for supravalvar right ventricular outflow tract obstruction(RVOTO) after arterial switch operation(ASO) is unclear. The results of percutaneous balloon dilatation have been variable. We report the results of simultaneous double balloon dilation for RVOTO after ASO. Sixteen patients (1.3(0.7-3.8) years; 9.8(8.1-15.1) kgs underwent the procedure at 14(8-44.5) months after ASO. Salient technical features included placement of balloons over stiff guide-wires positioned in both branch pulmonary arteries to enable dilation of the distal-most main pulmonary artery (MPA) with high inflation pressures (~ 12-14 atmospheres) and short inflation-deflation cycles. Effective balloon size was based on the PA annulus or MPA distal to the narrowing. The final balloon: narrowest segment diameter ratio was 2.7. Following dilation, the right ventricle to systemic systolic pressure ratio decreased from 0.9 ± 0.18 to 0.52 ± 0.16 (p < 0.001) and mean RVOT gradient from 78 ± 18 to 34 ± 13.9 mmHg (p < 0.001). Narrowest diameter improved from 5.4 ± 2.2 to 9.2 ± 2.2 mm. There were no major complications. Two patients with inadequate relief (final RV-systemic ratios: 1.03 and 0.7) were referred for surgery. At median follow up of 9 months, IQR 7-22, range 5-73, others are free of re interventions with median RVOT gradient of 42, IQR 27-49, range 21-55 mmHg. The immediate and short-term follow up results of double balloon dilatation for supravalvar RVOTO is encouraging and may avoid the need for repeat surgery in the majority of patients. Further follow up is needed to determine the long-term durability of the results.
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Affiliation(s)
- Navaneetha Sasikumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India.
| | - Sujata Alawani
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India
| | - Abish Sudhakar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India
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Interventions after Arterial Switch: A Single Low Case-Volume Center Experience. ACTA ACUST UNITED AC 2021; 57:medicina57050401. [PMID: 33919045 PMCID: PMC8142980 DOI: 10.3390/medicina57050401] [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: 03/05/2021] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: With the growing population of arterial switch operation survivors, the rate of late complications associated with the operation is growing as well. The aim of this publication is to share our experience and encourage collaboration between congenital cardiac surgeons and interventional cardiologists in treating late complications after arterial switch operation. Materials and Methods: A retrospective analysis of Vilnius University Santaros Clinics Cardiothoracic Surgery Centre arterial switch operation survivors who underwent additional treatment for late neo-pulmonary artery stenosis and aortic arch obstruction between 1989 and 2019 was conducted. Results: Out of 95 arterial switch operation survivors 14 (15%) underwent 36 reinterventions. The majority were treated for neo-pulmonary stenosis. The median time from arterial switch operation to the first reintervention was 1.4 years (interquartile range, 2 months to 2.4 years). 1, 3, 5, and 10 years intervention-free survival in patients treated for neo-pulmonary stenosis and aortic arch obstruction was 98, 94, 94, and 93% vs. 95, 94, 94, and 93%, respectively. There were no complications associated with redo surgical procedures, while eight patients who underwent catheter-based interventional treatment had treatment-related complications, including one death. Conclusions: Both neo-pulmonary stenosis and aortic arch obstruction (new aortic coarctations or aortic recoarctations) tend to develop in the first decade after an arterial switch operation. Surgical and catheter-based interventional treatment with good results is possible even in a small volume center. Close collaboration of the congenital heart team (congenital cardiac surgeons and interventional cardiologists) in choosing the best treatment option for an individual patient helps to minimize the risk of potential complications.
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Chongthammakun V, Mitchell ME, Gudausky TM, Bartz PJ, Foerster SR. Cardiac Arrest Secondary to Traumatic Aortopulmonary Window During Transcatheter Pulmonary Valve Implantation in Supported Ross. JACC Case Rep 2019; 1:746-750. [PMID: 34316924 PMCID: PMC8289145 DOI: 10.1016/j.jaccas.2019.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/20/2022]
Abstract
We present a patient with a supported Ross procedure and severe pulmonary homograft stenosis who developed cardiac arrest while undergoing transcatheter pulmonary valve replacement and was found to have a large iatrogenic aortopulmonary window. Cardiopulmonary resuscitation was initiated followed by covered stent placement, extracorporeal membrane oxygenation support, and ultimately emergent surgery with a good outcome. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Vasutakarn Chongthammakun
- Address for correspondence: Dr. Vasutakarn Chongthammakun, Adult Congenital Heart Disease Program, Herma Heart Institute, Children’s Hospital of Wisconsin, Medical College of Wisconsin, 8915 West Connell Court, Milwaukee, Wisconsin 53226.
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Lee J, Abdullah Shahbah D, El-Said H, Rios R, Ratnayaka K, Moore J. Pulmonary artery interventions after the arterial switch operation: Unique and significant risks. CONGENIT HEART DIS 2019; 14:288-296. [PMID: 30620141 DOI: 10.1111/chd.12726] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/17/2018] [Accepted: 11/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the modern era, results of the arterial switch operation (ASO) for transposition of the great arteries are excellent. However, because of the LeCompte maneuver, there may be a propensity for development of pulmonary artery stenosis. We encountered atypical complications of pulmonary artery stenting in patients after the ASO, including aorto-pulmonary fistula and coronary compression. METHODS We performed a 10-year retrospective review of catheterizations performed in patients after ASO in our institution with a focus on adverse events. RESULTS Diagnostic and interventional catheterizations were performed in 47 patients. In 29 patients, 37 interventional procedures performed, which included pulmonary artery angioplasty and/or stenting. In this group, there were five major adverse events (14%), including three aorto-pulmonary fistulae and one coronary artery compression among patients having stent implantation or stent redilation. In addition, there were 6/37 (16%) intended stent procedures, which were aborted because there appeared to be high-risk of significant adverse events. CONCLUSIONS This review suggests that percutaneous intervention on pulmonary artery stenosis after ASO has high-risk and should be undertaken advisedly. Prior thorough evaluation of coronary arteries is mandatory as coronary reimplantation sites may be adjacent to sites of pulmonary artery stenosis. Furthermore, if pulmonary artery stent implantation or stent redilation is contemplated, the risk of stent fracture and possible AP fistula should be recognized. Primary use of reinforced covered stents should be considered.
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Affiliation(s)
- Jesse Lee
- Department of Pediatric Cardiology, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - Doaa Abdullah Shahbah
- Department of Pediatric Cardiology, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - Howaida El-Said
- Department of Pediatric Cardiology, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - Rodrigo Rios
- Department of Pediatric Cardiology, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - Kanishka Ratnayaka
- Department of Pediatric Cardiology, Rady Children's Hospital, University of California San Diego, San Diego, California
| | - John Moore
- Department of Pediatric Cardiology, Rady Children's Hospital, University of California San Diego, San Diego, California
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A rare complication of balloon pulmonary angioplasty: Aortopulmonary window and its treatment. Anatol J Cardiol 2018; 21:46-47. [PMID: 30587706 PMCID: PMC6382906 DOI: 10.14744/anatoljcardiol.2018.24704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Torres A, Sanders SP, Vincent JA, El-Said HG, Leahy RA, Padera RF, McElhinney DB. Iatrogenic aortopulmonary communications after transcatheter interventions on the right ventricular outflow tract or pulmonary artery: Pathophysiologic, diagnostic, and management considerations. Catheter Cardiovasc Interv 2015; 86:438-52. [PMID: 25676815 DOI: 10.1002/ccd.25897] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 02/07/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate the spectrum, etiology, and management of traumatic aortopulmonary (AP) communications after transcatheter interventions on the pulmonary circulation. BACKGROUND An iatrogenic AP communication is an unusual complication after balloon pulmonary artery (PA) angioplasty or stenting, or transcatheter pulmonary valve replacement (TPVR). However, with the increasing application of transcatheter therapies for postoperative PA stenosis and right ventricular outflow tract (RVOT) dysfunction, including percutaneous pulmonary valve replacement, consideration of the etiology, diagnosis, and management of this problem is important for interventional cardiologists performing such procedures. METHODS AND RESULTS We present three new cases, as well as gross anatomy and histopathology data, related to AP communications after PA interventions. We also review the literature relevant to this topic. Including these new cases, there have been 18 reported cases of iatrogenic AP communication after transcatheter interventions on the PAs or RVOT, primarily patients with transposition of the great arteries who underwent PA angioplasty after an arterial switch operation, or after TPVR in patients who had undergone a Ross procedure. The likely cause of such defects is PA trauma plus distortion of the neo-aortic anastomosis resulting from angioplasty or stenting of the RVOT or central PAs, with subsequent dissection through the extravascular connective tissue and into the closely adjacent vessel through the devitalized tissue at the anastomosis. CONCLUSIONS Cardiologists performing PA or RVOT interventions should be aware of the possibility of a traumatic AP communication and consider this diagnosis when confronted with suggestive signs and symptoms.
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Affiliation(s)
- Alejandro Torres
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Stephen P Sanders
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Julie A Vincent
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Howaida G El-Said
- Department of Pediatrics, University of California, San Diego, California
| | - Ryan A Leahy
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Robert F Padera
- Department of Pathology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Lucille Packard Children's Hospital Stanford, Palo Alto, California
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González-López MT, Gil-Jaurena JM, Zunzunegui-Martínez JL, Álvarez-García-Rovés R. Aortopulmonary window due to transcatheter pulmonary valve implantation after arterial switch operation: Where is the limit? J Thorac Cardiovasc Surg 2015; 149:e38-9. [DOI: 10.1016/j.jtcvs.2014.10.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 10/11/2014] [Indexed: 10/24/2022]
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Coserria F, Mendez A, Moruno A, Valverde I, Santos de Soto J. Cierre percutáneo de fístula aortopulmonar iatrogénica con dispositivo Amplatzer Septal Occluder®. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Percutaneous closure of iatrogenic aortopulmonary fistula using the Amplatzer Septal Occluder. ACTA ACUST UNITED AC 2014; 67:228-9. [PMID: 24774403 DOI: 10.1016/j.rec.2013.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/13/2013] [Indexed: 11/20/2022]
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Kenny D, Holoshitz N, Turner D, Hijazi ZM. Aortopulmonary Fistula After Transcatheter Pulmonary Valve Replacement. Circ Cardiovasc Interv 2013; 6:e67-8. [DOI: 10.1161/circinterventions.113.000654] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Damien Kenny
- From the Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, IL
| | - Noa Holoshitz
- From the Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, IL
| | - David Turner
- From the Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, IL
| | - Ziyad M. Hijazi
- From the Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, IL
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Adams RF, Argilla M, Srichai MB. Iatrogenic Aortopulmonary Window and Pulmonary Artery Dissection Secondary to Aortic Cannulation. Circulation 2013; 128:e180-1. [DOI: 10.1161/circulationaha.112.001364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert F. Adams
- From the Department of Pediatrics, Division of Pediatric Cardiology, New York University School of Medicine, New York, NY (R.F.A., M.A.); and Department of Medicine, Division of Cardiology, Medstar Georgetown University Hospital, Washington, DC (M.B.S.)
| | - Michael Argilla
- From the Department of Pediatrics, Division of Pediatric Cardiology, New York University School of Medicine, New York, NY (R.F.A., M.A.); and Department of Medicine, Division of Cardiology, Medstar Georgetown University Hospital, Washington, DC (M.B.S.)
| | - Monvadi B. Srichai
- From the Department of Pediatrics, Division of Pediatric Cardiology, New York University School of Medicine, New York, NY (R.F.A., M.A.); and Department of Medicine, Division of Cardiology, Medstar Georgetown University Hospital, Washington, DC (M.B.S.)
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Iatrogenic aortopulmonary fistula occurring after pulmonary artery balloon angioplasty: a word of caution. Pediatr Cardiol 2013; 34:1267-8. [PMID: 22644415 DOI: 10.1007/s00246-012-0377-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
Abstract
We describe the natural history of an adolescent patient who developed an aortopulmonary fistula (APF) after transcatheter stent placement for left pulmonary artery stenosis after neonatal repair of d-transposition of the great arteries. Due to its rarity, the APF was not initially diagnosed and treated until 4 months later. The APF was occluded with a covered stent. Because this is not an isolated report in the literature, we believe it should be considered as a potential complication in all patients after balloon dilation of stenotic pulmonary artery branches after arterial switch surgery.
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