Isolated left pulmonary artery: Interventional stenting of a persistent fifth aortic arch

Koch, Andreas; Ludwig, Josef; Zink, Stefan; H, Singer

doi:10.1002/ccd.21099

Cited by 7 publications

(12 citation statements)

References 41 publications

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“…The potential benefit of drug-eluting stents (DES) is attenuation of neointimal proliferation, which has been extensively described in adults with coronary arterial disease. [188] For use in CHD, implantation of DES has been reported in the arterial duct feeding an isolated left PA,[189] a conduit in the RVOT of an infant,[189190] the vertical vein of a supracardiac totally anomalous pulmonary venous connection,[191] an obstructed infracardiac totally anomalous pulmonary venous connection[192] and a pulmonary vein stenosis after orthotopic heart transplantation. [129] As most of the experience with DES comes from coronary stents in adults, the efficacy and safety of these devices in CHD and for pediatric use remain unknown.…”

Section: Biodegradable Stentsmentioning

confidence: 99%

The role of stents in the treatment of congenital heart disease: Current status and future perspectives

2009

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Intravascular or intracardiac stenoses occur in many forms of congenital heart disease (CHD). Therefore, the implantation of stents has become an accepted interventional procedure for stenotic lesions in pediatric cardiology. Furthermore, stents are know to be used to exclude vessel aneurysm or to ensure patency of existing or newly created intracardiac communications. With the further refinement of the first generation of devices, a variety of “modern” stents with different design characteristics have evolved. Despite the tremendous technical improvement over the last 20 years, the “ideal stent” has not yet been developed. Therefore, the pediatric interventionalist has to decide which stent is suitable for each lesion. On this basis, currently available stents are discussed in regard to their advantages and disadvantages for common application in CHD. New concepts and designs developed to overcome some of the existing problems, like the failure of adaptation to somatic growth, are presented. Thus, in the future, biodegradable or growth stents might replace the currently used generation of stents. This might truly lead to widening indications for the use of stents in the treatment of CHD.

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Section: Biodegradable Stentsmentioning

confidence: 99%

The role of stents in the treatment of congenital heart disease: Current status and future perspectives

2009

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“…31 A systemic-to-pulmonary persistent fifth aortic arch also has the potential to act as a vital aortopulmonary connection when associated with critical pulmonary obstructive lesions such as pulmonary atresia, [32][33][34] tetralogy of Fallot, 35 and an isolated left pulmonary artery. 34,36 Systemic-to-pulmonary persistent fifth aortic arch in this context has been associated with abnormalities of chromosome 22q11. 34,37 As with the systemic-to-systemic form, case reports exist where patency has been maintained with intravenous prostaglandin.…”

Section: Systemic-to-systemic Persistent Fifth Aortic Archmentioning

confidence: 99%

Persistent fifth aortic arch: the “great pretender” in clinical practice

Lloyd

Pushparajah

et al. 2017

Cardiol Young

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Persistence of the embryonic "fifth aortic arch" in postnatal life is a rare, enigmatic - and at times controversial - condition, with variable anatomical forms and physiological consequences. First described in humans over 40 years ago by Van Praagh, the condition was labelled the "great pretender" by Gerlis 25 years later, because of its apparent propensity to mimic anatomically similar structures. Despite many subsequent case reports citing the condition, the true developmental origin of these structures remains unresolved, and has been the subject of debate among embryologists for more than a century. A persistent fifth aortic arch has been defined as an extrapericardial structure, arising from the ascending aorta opposite or proximal to the brachiocephalic artery, and terminating in the dorsal aorta or pulmonary arteries via a persistently patent arterial duct. This description may therefore encompass various anatomical forms, such as a unilateral double-lumen aortic arch, an unrestrictive aortopulmonary shunt, or a critical vascular channel for either the systemic or pulmonary circulation. The physiological properties of these vessels, such as their response to prostaglandins, may also be unpredictable. In this article, we demonstrate a number of cases that fulfil the contemporary definition of "persistent fifth aortic arch" while acknowledging the embryological controversies associated with this term. We also outline the key diagnostic features, particularly with respect to the use of new cross-sectional imaging techniques.

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“…24 Recently, a rapamycin DES was implanted in the arterial ductal component of an isolated left pulmonary artery in a 7-week-old infant with follow-up stent patency confirmed at 7 months. 25 Clinical studies of coronary artery stents demonstrated substantially reduced in-stent intimal hyperplasia with the DES compared with the BMS, translating to a reduction in the need for repeat revascularization procedures. 17,18 This initial enthusiasm and change in practice toward the DES have been tempered by safety concerns around emerging evidence of late thrombosis (1.3%) associated with the DES compared with BMS.…”

Section: Rapamycin: Clinical Applicationsmentioning

confidence: 99%

Rapamycin-Eluting Stents in the Arterial Duct

et al. 2009

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Background-Maintaining arterial duct patency by stent implantation may be advantageous in congenital heart disease management algorithms. Rapamycin, an immunosuppressant drug that demonstrates antiproliferative properties and inhibits smooth muscle cell migration, may deter the intimal hyperplasia that occurs during spontaneous closure and after-stent implantation of the arterial duct. Methods and Results-Twenty-eight Yorkshire piglets (7 to 11 days old; weight, 2.2 to 4.9 kg) underwent stent implantation of the arterial duct (rapamycin-eluting (nϭ14) or bare metal (nϭ14) stents, 3.5-mm diameter) and were euthanized at 2, 4, and 6 weeks. Dissected arterial ducts were analyzed for lumen diameter, smooth muscle cell, and extracellular matrix components. Isolated arterial duct-derived smooth muscle cells were cultured in the presence or absence of rapamycin. Cellular proliferation rates were assessed by Ki-67 detection and [ 3 H]-thymidine incorporation. No significant neointimal proliferation was present in either stent type at 2 weeks. At 4 weeks, the median luminal diameters of the bare metal stents were 87% (Pϭ0.009), 54% (Pϭ0.004), and 77% (Pϭ0.004) that of the drug-eluting stents at the middle and aortic and pulmonary artery ends, respectively. At 6 weeks, the median luminal diameters of the bare metal stents were 0% (Pϭ0.18), 5% (Pϭ0.25), and 61% (Pϭ0.13) that of the drug-eluting stents at the same respective levels. Complete histological occlusion was found in at least 1 level of the lumen in 9 pigs: 1 (17%) in the BMS group at 4 weeks, 5 (83%) in the BMS group at 6 weeks, and 3 (50%) in the DES group at 6 weeks. In vitro studies demonstrated 50%-lower proliferation rates in rapamycin-treated cultures of duct-derived smooth muscle cell cultures (PϽ0.001). Conclusions-Rapamycin has antiproliferative actions on the arterial duct. Drug-eluting stents may be a more efficient tool than current palliative options for maintaining patency in critically duct-dependent states, but there may be a finite time-related benefit.

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Isolated left pulmonary artery: Interventional stenting of a persistent fifth aortic arch

Cited by 7 publications

References 41 publications

The role of stents in the treatment of congenital heart disease: Current status and future perspectives

The role of stents in the treatment of congenital heart disease: Current status and future perspectives

Persistent fifth aortic arch: the “great pretender” in clinical practice

Rapamycin-Eluting Stents in the Arterial Duct

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