Creation of a functional Potts shunt by stenting the persistent arterial duct in newborns and infants with suprasystemic pulmonary hypertension of various etiologies

Treatment of pulmonary arterial hypertension in children

“…Another benefit arises from its effect on h aemodynamics-the relief of right ventricular pressure overload in systole and, in part, also in diastole, with a subsequent reduction in shifting of the interventricular septum to the left ventricle, and an improvement in s ystolic and diastolic left ventricular performance. 13 The connection between the pulmonary artery and the descending aorta can be achieved either by a direct sideby-side anastomosis or by using a synthetic graft tube or prosthesis (polytetrafluoroethylene has been used in three patients at our institution), which should be the same size as the descending aorta to allow sufficient decompression of the right ventricle. Run-off through the Potts shunt with decreased pulmonary perfusion and extreme de saturation of the lower body with subsequent undersupply of the myocardium and the brain should be avoided.…”

“…133,134 In another series of four patients, our group was able to confirm the usefulness and safety of stenting of a patent ductus arteriosus in neonates and infants with variant forms of severe PH. 13 Further development of the technical aspects of the Potts procedure include the implantation of a unidirectional valve within the Potts anastomosis, which can be considered for patients with PH and subsystemic or isosystemic pulmonary artery pressures who exhibit suprasystemic pulmonary artery pressures during exercise, 135 and in patients in whom bidirectional shunting occurs after decompression of the right ventricle.…”

“…13 Stenting of the patent ductus arteriosus was performed to allow acute right ventricular decompression in the presence of impaired systolic right ventricular and diastolic left ventricular function, and enabled functional recovery and subsequent uncomplicated biventricular repair during follow-up. Given the limited treatment options for patients with severe PH owing to left heart disease, the Nature Reviews | Cardiology * * combined interventional creation of an interatrial communication and surgical or interventional implantation of a Potts shunt might be a promising treatment strategy.…”

“…Previously, these techniques were primarily performed to palliate children and young adults with severe PAH or PH owing to left heart disease with an additional reactive precapillary component. [10][11][12][13][14] The new developments were mainly the result of clinical experience from patients with congenital heart disease, particularly those with Eisenmenger syndrome, which is the most advanced form of PAH in patients with congenital heart disease. 15,16 Eisenmenger syndrome is defined as a (usually untreated) congenital heart disease with shunts on an atrial, ventricular, and/or arterial level that lead to pulmonary hypertension, reversal of shunt flow, and general or only lower body cyanosis.…”

Potts shunt for pulmonary hypertension: the interventionist's interest in imaging

“…Artificial ‘re-ducting’ combines the goals of first unloading the pressure-stressed subpulmonary ventricle and, second, improving systemic blood flow by bypassing the lung without the expense of cyanosis of the coronary and cerebral circulation. In case reports, transcatheter techniques have been used to re-establish a right-to-left shunting duct in young children with suprasystemic pulmonary hypertension of various aetiologies6 7 as well as by a de novo communication between the LPA and DAO 8 9. Still, there is an intense ‘learning curve’ before we reach the point where the safety and efficacy of a transcatheter Potts shunt creation will overcome the high risk of the surgical approach.…”