Ductal stenting to improve pulmonary blood flow in pulmonary atresia with intact ventricular septum and critical pulmonary stenosis after balloon valvuloplasty

Haddad, Raymond N.; Hanna, Najib; Charbel, Ramy; Daou, Linda; Chehab, Ghassan; Saliba, Zakhia

doi:10.1017/s1047951119000118

Cited by 11 publications

(6 citation statements)

References 24 publications

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“…In contrast, ductal stenting immediately after balloon pulmonary valvuloplasty exhibited several advantages: repetitive transfers to the catheterisation laboratory as well as recurrent vascular access were avoided. 10 In our cohort, we preferred to perform additional interventions in the same setting, and we believe that it decreased our vascular complication rates (1%). Axillary or carotid artery access can be used in patients with a vertical ductus that originates proximally from the underside of the aortic arch.…”

Section: Discussionmentioning

confidence: 92%

Early and midterm results of ductal stent implantation in neonates with ductal-dependent pulmonary circulation: a single-centre experience

et al. 2020

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Objective: We aimed to determine the early and midterm outcomes of ductal stenting in neonates with ductal-dependent pulmonary blood flow. Methods: Between January, 2014 and July, 2018, 102 patients who underwent 115 cardiac catheterisation procedures for ductal stent implantation in our department were retrospectively reviewed. The age of the neonates ranged from 3 to 30 days (median: 11 days) and their weights ranged from 1.8 to 5.8 kg (mean, 2.8 ± 0.53 kg). Fifty-two patients had functional single ventricle and 50 had biventricular physiology. Thirty-one patients’ weights were <2,500 g (30.3%). The patent ductus arteriosus was vertical in 60 patients (58.8%). The mean ductal length was 12.4 ± 4.1 mm (range, 7.8–23 mm), and the mean narrowest ductal diameter was 2.1 ± 0.7 mm (range, 1.2–3.4 mm). Results: The technical success rate was 85.2%. Procedure-related mortality occurred in three patients (2.9%). After the procedure, the aortic oxygen saturation increased from a mean of 73.1 ± 6.2% to a mean of 90.4 ± 4.3% (p < 0.001), and the ductus diameter increased from a mean of 2.1 ± 0.7 mm to a mean of 4.2 ± 0.9 mm (p < 0.001). Either transcatheter or surgical reinterventions were required in 35 patients (34.3%) during the follow-up period after a median of 101 days (2–356 days). Thirty-three patients (32.3%) were bridged to surgical repair after a median of 288 days (163–650 days). The median duration of palliation with ductal stents was 210 days (range, 2–525 days). Conclusion: Ductus arteriosus stenting may be a reasonable and effective alternative to surgery for the initial palliation procedure in neonates with ductus-dependent pulmonary flow.

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Section: Discussionmentioning

confidence: 92%

Early and midterm results of ductal stent implantation in neonates with ductal-dependent pulmonary circulation: a single-centre experience

et al. 2020

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“…For PA/IVS patients with ner PDA, continuous infusion is needed, while other patients are prepared for emergency use. In addition, when stent implantation is needed, the infusion of PGE1 needs to be suspended to obtain the best catheter contraction, reduce the occurrence of catheter stent-related complications, and may also help to minimize the problems related to pulmonary circulation excess [19].…”

Section: Discussionmentioning

confidence: 99%

Anesthesia management of interventional cardiac catheterization for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS): a retrospective analysis

Zhang

Wang

et al. 2023

Preprint

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Background Pulmonary atresia with intact ventricular septum (PA/IVS) and critical pulmonary stenosis (CPS) usually have to undergo treatment in the neonatal period, as their pulmonary blood flow (PBF) depends on the patent ductus arteriosus (PDA). Recent studies have shown that catheter-based cardiac interventions may achieve similar or superior outcomes for neonates with PA/IVS and CPS compared to traditional surgical intervention. However, there is limited literature on anesthesia techniques, challenges, and risks associated with cardiac catheterization in this population. Methods This article retrospectively analyzed the clinical data of PA/IVS and CPS neonates who were treated with interventional cardiac catheterization in our hospital from January 2015 to October 2022. A special clinical protocol for anesthetic management of these patients was utilized throughout the study period. Clinical outcomes considered were hemodynamic or SpO2 instability, vasoactive requirements, prolonged intubation (>24 h postoperatively) and cardiovascular adverse events. Results A total of 63 patients met the inclusion criteria. Central venous catheter and invasive arterial blood pressure monitoring were provided for 26 neonates during the perioperative period. All patients survived the intervention. Among the patients with CPS, 40 successfully received percutaneous balloon pulmonary valvuloplasty (PBPV), while three patients received ductal stenting due to moderate right ventricular dysplasia at the same time. For patients with PA/IVS, 17 of the 23 patients successfully underwent percutaneous pulmonary valve perforation (PPVP) and PBPV. Of these, five patients underwent ductal stenting due to unstable PBF. Three patients only underwent ductal stenting. In addition, three patients received hybrid therapy. Compared with CPS, the procedural time and anesthesia time of PA/IVS were significantly prolonged, as were the numbers of patients using prostaglandin E1 and vasoactive drugs in the perioperative period, and postoperative mechanical ventilation time >24 h was also significantly increased. Conclusions There are various clinical techniques and risk challenges in the interventional cardiac catheterization of neonatal PA/IVS and CPS. However, by mastering the physiological and pathophysiological characteristics of the disease, adequately preparing for the perioperative period, predicting the procedure process and potential complications, anesthesia and surgical risks can be effectively managed. Compared with CPS neonates, PA/IVS neonates have a higher perioperative risk and incidence of cardiovascular adverse events.

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“…According to these studies, a TV z-score of over −2.5 SD is recognized as a good marker for biventricular repair and with TV z-score of −4.5 to −2.5 SD considered a borderline RV. In patients with borderline RV size, a sufficient increase in PBF immediately after successful valve perforation is not guaranteed, and some patients require an additional PBF source, such as a surgical shunt or stent into the PDA or RVOT 8,16 . However, it is well known that RV growth is favorable after pulmonary valve perforation and RV decompression [17][18][19] .…”

Section: Preprocedural Evaluationmentioning

confidence: 99%

“…With the refinement of chronic total occlusion (CTO) hardware technology, mechanical valve perforation using a CTO wire has been introduced as a technique with lower cost and risk of complications [25][26][27][28] . Because CTO wires are specially designed to penetrate occluded coronary arteries, they can provide better penetrability, straightforward pushability, and stability during perforation, which can reduce catheter displacement and subsequent cardiac perforation 16 . On the contrary, success rate in previous reports was as high as RF perforation 26,27,29 .…”

Section: Valve Perforation and Balloon Dilationmentioning

confidence: 99%

Current status of transcatheter intervention for complex right ventricular outflow tract abnormalities

Kagiyama,

Kenny,

Hijazi

2023

gcsp

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Various transcatheter interventions for the right ventricular outflow tract (RVOT) have been introduced and developed in recent decades. Transcatheter pulmonary valve perforation was first introduced in the 1990s. Radiofrequency wire perforation has been the approach of choice for membranous pulmonary atresia in newborns, with high success rates, although complication rates remain relatively common. Stenting of the RVOT is a novel palliative treatment that may improve hemodynamics in neonatal patients with reduced pulmonary blood flow and RVOT obstruction. Whether this option is superior to other surgical palliative strategies or early primary repair of tetralogy of Fallot remains unclear. Transcatheter pulmonary valve replacement has been one of the biggest innovations in the last two decades. With the success of the Melody and SAPIEN valves, this technique has evolved into the gold standard therapy for RVOT abnormalities with excellent procedural safety and efficacy. Challenges remain in managing the wide heterogeneity of postoperative lesions seen in RVOT, and various technical modifications, such as pre-stenting, valve ring modification, or development of self-expanding systems, have been made. Recent large studies have revealed outcomes comparable to those of surgery, with less morbidity. Further experience and multicenter studies and registries to compare the outcomes of various strategies are necessary, with the ultimate goal of a single-step, minimally invasive approach offering the best longer-term anatomical and physiological results.

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Ductal stenting to improve pulmonary blood flow in pulmonary atresia with intact ventricular septum and critical pulmonary stenosis after balloon valvuloplasty

Cited by 11 publications

References 24 publications

Early and midterm results of ductal stent implantation in neonates with ductal-dependent pulmonary circulation: a single-centre experience

Early and midterm results of ductal stent implantation in neonates with ductal-dependent pulmonary circulation: a single-centre experience

Anesthesia management of interventional cardiac catheterization for pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS): a retrospective analysis

Current status of transcatheter intervention for complex right ventricular outflow tract abnormalities

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