Central Shunt Procedures for Complex Congenital Heart Diseases

Bao, Min; Li, Hongyin; Pan, Gang; Xu, Zhiyun; Wu, Qingyu

doi:10.1111/jocs.12343

Cited by 7 publications

(7 citation statements)

References 18 publications

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“…The complex flow structures observed in RPA and LPA may lead to abnormal PA growth. Simulation results shows that velocity distribution in LPA and RPA was relatively uniform in CS, which is consistent with the study by Bao et al [31]. Nevertheless, an obvious swirling phenomenon occurred at the RPA in MBTS resulting in formation of high vorticity regions.…”

Section: Discussionsupporting

confidence: 89%

Computational Fluid Dynamics Characterization of Two Patient-Specific Systemic-to-Pulmonary Shunts before and after Operation

Zhang

Yuan

Chen

et al. 2019

Computational and Mathematical Methods in Medicine

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Studying the haemodynamics of the central shunt (CS) and modified Blalock–Taussig shunt (MBTS) benefits the improvement of postoperative recovery for patients with an aorta-pulmonary shunt. Shunt configurations, including CS and MBTS, are virtually reconstructed for infants A and B based on preoperative CT data, and three-dimensional models of A, 11 months after CS, and B, 8 months after MBTS, are reconstructed based on postoperative CT data. A series of parameters including energy loss, wall shear stress, and shunt ratio are computed from simulation to analyse the haemodynamics of CS and MBTS. Our results showed that the shunt ratio of the CS is approximately 30% higher than the MBTS and velocity distribution in the left pulmonary artery (LPA) and right pulmonary artery (RPA) was closer to a natural development in the CS than the MBTS. However, energy loss of the MBTS is lower, and the MBTS can provide more symmetric pulmonary artery (PA) flow than the CS. With the growth of infants A and B, the shunt ratio of infants was decreased, but maximum wall shear stress and the distribution region of high wall shear stress (WSS) were increased, which raises the probability of thrombosis. For infant A, the preoperative abnormal PA structure directly resulted in asymmetric growth of PA after operation, and the LPA/RPA ratio decreased from 0.49 to 0.25. Insufficient reserved length of the MBTS led to traction phenomena with the growth of infant B; on the one hand, it increased the eddy current, and on the other hand, it increased the flow resistance of anastomosis, promoting asymmetric PA flow.

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Section: Discussionsupporting

confidence: 89%

Computational Fluid Dynamics Characterization of Two Patient-Specific Systemic-to-Pulmonary Shunts before and after Operation

Zhang

Yuan

Chen

et al. 2019

Computational and Mathematical Methods in Medicine

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“…Despite advancements in corrective surgeries for congenital heart defects (CHDs), systemic-to-pulmonary arterial shunts (SPSs) remain the most common in complex CHDs with inadequate pulmonary blood flow (1). Various types of surgical shunts are currently proposed including the classical or modified Blalock-Taussig shunt (BTS), and the central aortopulmonary shunt (APS) (2)(3)(4)(5)(6). Central APS is preferred in patients with small pulmonary arteries (5,(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Percutaneous stent implantation for occluded central shunts in adults: A case report and review of current evidence

Jenab

Rezaee

Hosseini

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPatients with cyanotic complex congenital heart defects (CHDs) commonly undergo palliation with interposition of systemic-to-pulmonary shunts (SPSs). These palliative shunts are rarely found in adults with CHDs and can be complicated with progressive obstruction or total occlusion during follow-up. The best treatment option for shunt re-permeabilization is challenging and case-oriented because most patients are high risk candidates for redo surgeries. We aimed to review the current evidence on percutaneous stent implantation to treat failed SPSs.MethodsWe performed a comprehensive literature review on percutaneous stent implantation to treat failed and occluded SPSs. We also reported the case of a 33-year-old man with cyanotic CHD and a occluded central aorto-pulmonary shunt, who was successfully treated with percutaneous balloon dilatation and subsequently stent implantation at our institution.ResultWe identified and included 31 articles reporting on 150 patients and 165 stent implantations in failed SPSs. The age of patients at the time of stent implantation ranged from 6 days to 47 years. The time between the surgical shunt creation and transcatheter intervention ranged from 1 day to 17 years. Overall, 161/165 (97.5%) stent implantations were successful. The most common clinical presentation was cyanosis and decreased atrial oxygen saturations and the indication for stent implantation was shunt obstruction and stenosis.ConclusionThis review highlights the benefits of endovascular stenting to permeabilize failed SPSs in children and adults with complex CHD who are classified as poor candidates for re-surgical repair.

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“…Early postoperative excessive pulmonary arterial blood flow results in pulmonary hypercirculation with pulmonary edema and low cardiac output. [12,[31][32][33] In Experience from vascular surgery by using HBPS show reduced platelet deposition, decrease in inflammatory responses and a reduction of thrombogenicity. Experience from vascular surgery suggests that HBPS may have a superior outcome in the case of thromboembolic risk than uncoated grafts or autologous venous material.…”

Section: Shunt Associated Problems and Possible Drawbacksmentioning

confidence: 99%

“…[41] Palliative shunt surgery is reported with early mortalities between 0% and 18.2% [11,12,22,23,27,28,32,33,[42][43][44][45], and late mortalities between 3.8% and 19%. [32,33,46] Reasons for unfavorable outcome were excessive pulmonary flow, sepsis, and arrhythmia or shunt thrombosis. [12,33,46] Mortality early and late after shunt operations is significant, despite being a non-complex surgical procedure.…”

Section: Survivalmentioning

confidence: 99%