Acute Interventions for Stenosed Right Ventricle-Pulmonary Artery Conduit Following the Right-Sided Modification of Norwood-Sano Procedure

Abstract

The RV-PA conduit stenosis is a life-threatening complication after the modified Norwood Stage I procedure. This may require urgent surgery to replace the conduit or to perform a cavo-pulmonary shunt but as an alternative, transcatheter stent placement can be used with equal effectiveness and with a low risk of complications. The catheter approach is less invasive and the results show that it is an excellent option to relieve the stenosis even in the right-sided RV-PA conduit.

Hypoplastic Left Heart Syndrome

“…More recently, the institution of the Sano modification resulted in documented cases of RV-PA conduit stenoses. Several published reports demonstrated endovascular stent placement in obstructed RV-PA conduits to be effective and safe (163,167–170). Complications include hypotension and blood loss, less commonly complete heart block and bradycardia, and rarely, cardiac arrest and death.…”

Stenting and overdilating small Gore‐Tex vascular grafts in complex congenital heart disease

“…For patients that develop graft obstruction, the risk of surgery versus catheter intervention must be weighed. Literature to date has reported the risks of shunt revision | 77 [2][3][4] and the feasibility of percutaneous graft stenting [1,3,[11][12][13][14][15][16][17][18] and overdilation [19][20][21][22]. This single-center cohort study now contributes a large experience of stent interventions and overdilation practice for small Gore-Tex ® grafts over a range of indications: addressing safety, technical results, and long-term clinical impact.…”

“…Balloon angioplasty to treat acutely stenosed shunts and conduits has been reported since the 1990s [5][6][7][8][9][10]. This was rapidly replaced by stent implantation (due to safety concerns), described in case reports and small series [1,[11][12][13][14][15][16][17][18]. Of late, graft stenting has emerged as an important interstage intervention [19], particularly in centers utilizing the Sano modification to classical Norwood [1,3,11].…”

“…This was rapidly replaced by stent implantation (due to safety concerns), described in case reports and small series [1,[11][12][13][14][15][16][17][18]. Of late, graft stenting has emerged as an important interstage intervention [19], particularly in centers utilizing the Sano modification to classical Norwood [1,3,11]. Using stents to overdilate Gore-Tex ® grafts beyond their (factory designated) nominal diameters was initially established on the bench and feasibility in vivo has since been described in a total of 15 patients in two series and one case report [12,[20][21][22].…”

Usefulness of balloon angioplasty for the right ventricle‐pulmonary artery shunt with the modified norwood procedure

“…As such, progressive desaturation between stages mandates either early conversion to bidirectional Glenn (BDG) anastomosis or catheter intervention to a stenotic RV‐PA shunt. Although there are a few case studies describing the efficacy of stent placement in the RV‐PA shunt , limited data exist regarding efficacy and durability of balloon angioplasty (BA) alone. In this study, we reviewed our institutional experiences of BA on the RV‐PA shunt focusing on the effectiveness of the procedure, reintervention and subsequent timing of stage II palliation.…”