Ductal stenting retrains the left ventricle in transposition of great arteries with intact ventricular septum

Sivakumar, Kothandam; Francis, Edwin; Krishnan, Prasad; Shahani, Jagdish

doi:10.1016/j.jtcvs.2006.07.014

Cited by 19 publications

(27 citation statements)

References 18 publications

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“…Hybrid approach to ductal stenting has been reported predominantly in conjunction with early palliation of hypoplastic left heart syndrome [8], however, we adapted the procedure to this small infant with TGA in an attempt to increase volume loading to the left ventricle prior to the arterial switch operation. This strategy has been described before in the setting of TGA, however in larger infants and via a femoral approach [9]. The procedure was technically straightforward, without complication and ductal patency was maintained until time of arterial switch a month later.…”

Section: Discussionmentioning

confidence: 99%

Variable approaches to arterial ductal stenting in infants with complex congenital heart disease

Kenny

Berman

Zahn

et al. 2012

Cathet Cardio Intervent

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Stenting of the arterial duct to maintain postnatal communication between the pulmonary and systemic arterial circulations in infants with complex congenital heart disease is an acceptable alternative to a surgically created systemic to pulmonary artery shunt. The procedure, however, can be demanding given the variable anatomy of the patent ductus arteriosus. We report a series of cases of ductal stenting via a range of varying approaches in neonates with complex congenital heart disease, and display the variety of situations in which these approaches may be used.

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Section: Discussionmentioning

confidence: 99%

Variable approaches to arterial ductal stenting in infants with complex congenital heart disease

Kenny

Berman

Zahn

et al. 2012

Cathet Cardio Intervent

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“…23 Jonas and colleagues presented the concept of rapid two-stage anatomical repair, in which the interstage period was significantly short (5-7 days). 10 On the other hand, we prefer this alternative approach with pulmonary banding and Glenn procedure in patients older 3 months of age as stage-1 palliation. 10 On the other hand, we prefer this alternative approach with pulmonary banding and Glenn procedure in patients older 3 months of age as stage-1 palliation.…”

Section: Discussionmentioning

confidence: 99%

“…6 Beyond the neonatal period, preparing or "retraining" the LV for ASO in cases with TGA is mandatory when the interventricular septum is intact (TGA-IVS). 10 Herein, we would like to present an alternative left ventricular training procedure for such cases in which we perform bidirectional cavopulmonary anastomosis (Glenn procedure) along with PAB. 7 The mortality of this first step of a two-stage ASO may be as high as 15% due to complications such as low cardiac output, hypoxemia necessitating a secondary intervention for shunt resizing, aortic regurgitation, decrease in pulmonary band gradient in the early postoperative period.…”

Section: Introductionmentioning

confidence: 99%

A better approach for left ventricular training in transposition of the great arteries and intact interventricular septum: Bidirectional cavopulmonary anastomosis and pulmonary artery banding

Bilal

Özyüksel

Avsar

et al. 2019

Congenital Heart Disease

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Objective: Management of the patients with transposition of the great arteries and intact ventricular septum may be challenging beyond the newborn period. Herein, we would like to present our alternative strategy for training the left ventricle in these patients. Methods:Six patients with transposition of the great arteries and intact ventricular septum were evaluated in our clinic. Two of them were palliated with Glenn procedure and pulmonary banding as a definitive treatment strategy at other centers. Four patients were operated on and a bidirectional cavopulmonary anastomosis in combination with pulmonary artery banding was performed (stage-1: palliation and ventricular training) in our center. In four out of these six patients, arterial switch operation was performed with takedown and direct re-anastomosis of the superior vena cava to right atrium after an interstage period of 21-30 months (stage-2: anatomical repair).Results: Any mortality was not encountered. The left ventricular mass indices increased from 18-32 to 44-74 g/m 2 in patients undergoing the anatomical repair. All of the patients were uneventfully discharged following the second stage. The mean follow-up period was 20 months (9-32 months) following stage 2. All of the patients are doing well with trivial neoaortic regurgitation and normal biventricular function. Conclusions:Bidirectional cavopulmonary anastomosis with pulmonary artery banding may be a promising left ventricle training approach in ventriculoarterial discordance when compared to the traditional pulmonary artery banding with concomitant systemic-to-pulmonary artery shunt procedures which still carry a significant interstage morbidity and mortality. K E Y W O R D Sarterial switch operation, bidirectional Glenn procedure, intact ventricular septum, modified Blalock-Taussig shunt, transposition of the great arteries

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“…in 2006. [5] He described successful ductal stenting and subsequent ASO in two children aged 3 months and both had a flowing PDA. We extended this technique to children beyond 3 months of age and to patients with an occluded duct.…”

Section: Discussionmentioning

confidence: 99%

“…Left ventricular retraining by ductal stenting may retrain the LV with less morbidity. [5] Sivakumar et al . have described ductal stenting for TGA in two children aged 3 months with a small patent ductus arteriosus (PDA).…”

Section: Introductionmentioning

confidence: 99%

Ductal recanalization and stenting for late presenters with TGA intact ventricular septum

et al. 2011

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Introduction:The ideal management strategy for patients presenting late with transposition of great arteries (TGA), intact ventricular septum (IVS), and regressed left ventricle (LV) is not clear. Primary switch, two-stage switch, and Senning operation are the options. Left ventricular retraining prior to arterial switch by ductal stenting may be effective, but the experience is very limited.Methods:Five of six children aged 3–6 months with TGA-IVS and regressed LV underwent recanalization and transcatheter stenting of ductus arteriosus. The ductal stent was removed during arterial switch surgery.Results:The procedure was successful in 5/6 patients. All the patients had totally occluded ductus and needed recanalization with coronary total occlusion hardware. The ductus was dilated and stented with coronary stents. In all the patients, there was significant luminal narrowing despite adequate stent placement and deployment. Two patients needed reintervention for abrupt closure of the stent. Ductal stenting resulted in left ventricular preparedness within 7–14 days. One patient died of progressive sepsis after 14 days of stenting, even though the LV was prepared. Four patients underwent successful uneventful arterial switch surgery. During surgery, it was observed that the mucosal folds of duct were protruding through the struts of the stent in one patient.Conclusions:Ductal stenting is a good alternative strategy for left ventricular retraining in TGA with regressed LV even in patients with occluded ducts.

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Ductal stenting retrains the left ventricle in transposition of great arteries with intact ventricular septum

Cited by 19 publications

References 18 publications

Variable approaches to arterial ductal stenting in infants with complex congenital heart disease

Variable approaches to arterial ductal stenting in infants with complex congenital heart disease

A better approach for left ventricular training in transposition of the great arteries and intact interventricular septum: Bidirectional cavopulmonary anastomosis and pulmonary artery banding

Ductal recanalization and stenting for late presenters with TGA intact ventricular septum

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