Aortopulmonary Fistula after Multiple Pulmonary Artery Stenting and Dilatation for Postarterial Switch Supravalvular Stenosis

Pagé, Maude; Nastase, Oana-Caterina; Maes, Frédéric; Kefer, Joëlle; Sluysmans, Thierry; Poncelet, Alain; Rubay, Jean; Pasquet, Agnès

doi:10.1155/2015/371925

Cited by 3 publications

(7 citation statements)

References 4 publications

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“…Ten were closed: four with covered stents, 11,14,17,20 three with surgery, 12,13,19 two with aortic endografts 16,18 and one with a device. 15 In context of these few reports, we find our experience illuminating.…”

Section: Discussionmentioning

confidence: 99%

“…11 Eleven additional cases have been reported. [12][13][14][15][16][17][18][19][20] Five were after one or more angioplasties, and six cases occurred after angioplasty and stent implantation. Of the stented cases, none were noted to have stent disruptions or fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Among these patients, the primary diagnosis was d-TGA with intact IVS (19), d-TGA with ventricular septal defect (VSD) (5), d-TGA with DORV (4), and d-TGA with other lesions (1). Among these patients, the primary diagnosis was d-TGA with intact IVS (19), d-TGA with ventricular septal defect (VSD) (5), d-TGA with DORV (4), and d-TGA with other lesions (1).…”

Section: Re Sultsmentioning

confidence: 99%

“…In 29 patients, we performed 37 procedures because of pulmonary artery stenosis. Among these patients, the primary diagnosis was d-TGA with intact IVS (19), d-TGA with ventricular septal defect (VSD) (5), d-TGA with DORV (4), and d-TGA with other lesions (1). Twenty-seven of the patients had neonatal arterial switch operations, and two had staged repairs.…”

Section: Re Sultsmentioning

confidence: 99%

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Pulmonary artery interventions after the arterial switch operation: Unique and significant risks

Lee

Shahbah

El‐Said

et al. 2019

Congenital Heart Disease

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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. K E Y W O R D Saorto-pulmonary fistula, arterial switch operation, pulmonary artery, stents, transposition of great vessels

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

See 2 more Smart Citations

Pulmonary artery interventions after the arterial switch operation: Unique and significant risks

Lee

Shahbah

El‐Said

et al. 2019

Congenital Heart Disease

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“…This is important because in vitro testing of stents with intentional fracture produces an irregular fracture pattern, with many stent struts protruding tangentially [13]. These externally protruding stent fragments can penetrate through blood vessels and damage adjacent soft tissue, including arteriovenous malformations [11,18,19]. However, pre-stenting allows realignment of the struts of intentionally broken stents, which remain embedded in the vessel wall, in a more ideal circular fashion.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Intentional Fracture of Previously Placed Stents: Impact of Pre-stenting in a Piglet Model

Bratincsák¹,

Alstine²,

Koren³

et al. 2017

jshd

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Background: Intentional stent fracture in vivo induces medial dissection/vessel injury. Spontaneous stent fracture in humans can lead to stent collapse, hemodynamic compromise, and embolization of stent fragments, which could be prevented by pre-stenting. Objectives: To evaluate the short-term and mid-term effects of pre-stenting prior to intentional stent fracture on vessel size and integrity in a piglet model. Methods: Five months after 14 low-profile stents (Cook Formula 418 stents) were implanted in the aorta of four piglets, they were intentionally fractured using ultra-high-pressure balloons with (pre-stent group) or without (single stent group) with another stent placed inside. Results: Compared with the single stent group, the prestent group showed a significantly larger vessel lumen area (109 mm2 (89-141) vs. 57 mm2 (47-73), P = 0.019), less mid-term luminal diameter loss (44% (26-59) vs. 75% (62-85), P = 0.007), lack of strut protrusion, and improved endothelialization (100% (89-100) vs. 73% (56-96), P = 0.022). Vessel wall injury was similar between groups at the time of stent fracture; however, the injury score was significantly improved at mid-term in the pre-stent group compared with the single stent group (P = 0.046). No damage to the external part of the blood vessels or the surrounding soft tissue was noted in either group. IntroductionStent implantation in younger patients is facilitated by the availability of low-profile stents that are deliverable through small delivery sheaths, although these smaller stents cannot be dilated to match an adult vessel size [1][2][3]. Several in vitro studies demonstrate that small-and medium-size stents can be fractured using ultra-high-pressure balloons [4,5]. Recently, an in vivo model of stent fracture (i.e., "unzipping") confirmed the feasibility of intentional fracture of several different stents in pigs; however, the report did not mention vessel patency after fracture and admitted to significant vessel injury secondary to intentional fracture, with Cook Formula stents associated with a slightly lower vessel injury score than other stents Conclusion: Pre-stenting before intentional stent fracture may provide advantages including larger vessel diameter, maintained vessel patency, more complete endothelialization, and lack of stent strut protrusion.

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Large Calibre Self-Expanding Stents for Pulmonary Stenosis After the Arterial Switch, a Low-Risk Solution to a Low-Flow Situation

et al. 2018

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Branch pulmonary artery stenosis is one of the most common complications late after the arterial switch operation. The pathophysiology of stenosis in these circumstances is very different to that encountered in with normally related great vessels. The LeCompte manoeuvre leaves the pulmonary arteries straddled and stretched over the aortic root which contributing significantly to the degree of stenosis encountered. Unilateral branch pulmonary artery stenosis rarely leads to significant symptoms in young patients with biventricular repairs; however, significant discrepancies in the split flows between right and left lung may place the patient in an unfavourable physiological position as they move in to middle age. Balloon expandable stent implantation distorts the anatomical arrangement of the LeCompte and is associated with negative interactions with the often dilated aortic root. We present three cases of the use of flexible self-expanding stents to improve the physiological flow distributions to each lung whilst hopefully decreasing the risk of erosion and perforation or fistula formation related to the pulmonary artery. All three patients had uncomplicated procedures with significant improvements in vessel diameter and flow distribution noted on follow-up MRI scans. This is the first report of the use of self-expanding stents in the context of branch pulmonary artery stenosis after the LeCompte manoeuvre. Theoretically and based on our early experience, this technique provides potential safety advantages over the use of more traditional balloon expandable stents.

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Aortopulmonary Fistula after Multiple Pulmonary Artery Stenting and Dilatation for Postarterial Switch Supravalvular Stenosis

Cited by 3 publications

References 4 publications

Pulmonary artery interventions after the arterial switch operation: Unique and significant risks

Pulmonary artery interventions after the arterial switch operation: Unique and significant risks

Intentional Fracture of Previously Placed Stents: Impact of Pre-stenting in a Piglet Model

Large Calibre Self-Expanding Stents for Pulmonary Stenosis After the Arterial Switch, a Low-Risk Solution to a Low-Flow Situation

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