Modified Microvascular Plug as a Flow Restrictor in Hypoplastic Left Heart Syndrome with Dysplastic Tricuspid and Pulmonary Valves

Kurtz, Joshua D.; Alsoufi, Bahaaldin; Wilkens, Sarah J.; Kim, Edward

doi:10.1007/s00246-021-02701-2

Cited by 15 publications

(13 citation statements)

References 13 publications

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“…Although these preliminary results are promising, technical limitations must be acknowledged. As previously reported, 7,8 device migrations and persistent overcirculation were observed during follow-up; therefore, the procedure was accordingly modified to address these issues. To better control the PBF, the fenestration technique required multiple adjustments; to prevent migrations, we initially oversized the implanted PFRs and later developed the RUPA technique.…”

Section: Discussionmentioning

confidence: 96%

“…Given the known risk of distal device embolization, 7,8 the MVPs were initially oversized by 1 size beyond the manufacturer’s recommendations, with limited success. However, starting from patient No.…”

Section: Methodsmentioning

confidence: 99%

“…A custom-made fenestrated micro vascular plug (Medtronic, Minneapolis, MN) was implanted in each PA using previously described techniques. [5][6][7][8][9] Given clinical and instrumental signs of suboptimal control of PBF in the initial patients, the fenestration technique was optimized over time as shown in Figure 1. In patient no.…”

Section: Procedural Techniquementioning

confidence: 99%

“…To date, there is limited experience with neonatal palliation with transcatheter pulmonary flow restrictors (PFRs). [5][6][7][8] We report our experience with PFRs in a cohort of high-risk surgical neonates, including procedure feasibility, technical details, and patient-level outcomes. Additionally, we compared a subcohort of high-risk SV patients palliated with PFR to a historical cohort who underwent a hS1.…”

mentioning

confidence: 99%

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Transcatheter Palliation With Pulmonary Artery Flow Restrictors in Neonates With Congenital Heart Disease: Feasibility, Outcomes, and Comparison With a Historical Hybrid Stage 1 Cohort

Sperotto,

Lang,

Nathan

et al. 2023

Circ: Cardiovascular Interventions

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Background: Neonates with complex congenital heart disease and pulmonary overcirculation have been historically treated surgically. However, subcohorts may benefit from less invasive procedures. Data on transcatheter palliation are limited. Methods: We present our experience with pulmonary flow restrictors (PFRs) for palliation of neonates with congenital heart disease, including procedural feasibility, technical details, and outcomes. We then compared our subcohort of high-risk single ventricle neonates palliated with PFRs with a similar historical cohort who underwent a hybrid Stage 1. Cox regression was used to evaluate the association between palliation strategy and 6-month mortality. Results: From 2021 to 2023, 17 patients (median age, 4 days; interquartile range [IQR], 2–8; median weight, 2.5 kilograms [IQR, 2.1–3.3]) underwent a PFR procedure; 15 (88%) had single ventricle physiology; 15 (88%) were high-risk surgical candidates. All procedures were technically successful. At a median follow-up of 6.2 months (IQR, 4.0–10.8), 13 patients (76%) were successfully bridged to surgery (median time since PFR procedure, 2.6 months [IQR, 1.1–4.4]; median weight, 4.9 kilograms [IQR, 3.4–5.8]). Pulmonary arteries grew adequately for age, and devices were easily removed without complications. The all-cause mortality rate before target surgery was 24% (n=4). Compared with the historical hybrid stage 1 cohort (n=23), after adjustment for main confounding (age, weight, intact/severely restrictive atrial septum or left ventricle to coronary fistulae), the PFR procedure was associated with a significantly lower all-cause 6-month mortality risk (adjusted hazard ratio, 0.26 [95% CI, 0.08–0.82]). Conclusions: Transcatheter palliation with PFR is feasible, safe, and represents an effective strategy for bridging high-risk neonates with congenital heart disease to surgical palliation, complete repair, or transplant while allowing for clinical stabilization and somatic growth.

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Section: Discussionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

Section: Procedural Techniquementioning

confidence: 99%

mentioning

confidence: 99%

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Transcatheter Palliation With Pulmonary Artery Flow Restrictors in Neonates With Congenital Heart Disease: Feasibility, Outcomes, and Comparison With a Historical Hybrid Stage 1 Cohort

Sperotto,

Lang,

Nathan

et al. 2023

Circ: Cardiovascular Interventions

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“…In the presence of obstructed pulmonary venous drainage, the reason for elevated mortality and morbidity has been attributed to severe hypertension in the pulmonary veins, causing either disorder of the fetal lung maturation with fibroelastosis of the alveolar septal parenchyma (68), increased medial thickness (arterialization) of the pulmonary veins and lymphangiectasis of the lung parenchyma (67)(68)(69)(70), or underdevelopment of the small pulmonary arteries with or without associated alveolar changes (65). To control the excessive pulmonary blood flow, an interventional cardiology technique using flow restrictors was first studied in animal experimental studies (71) and have now been successfully introduced in the clinical practice (72).…”

Section: Interventional Cardiology Proceduresmentioning

confidence: 99%

Narrative review of single ventricle: where are we after 40 years?

Corno¹,

Findley²,

Salazar³

2023

Transl Pediatr

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Background and Objective: Key medical and surgical advances have been made in the longitudinal management of patients with "functionally" single ventricle physiology, with the principles of Fontan circulation applied to other complex congenital heart defects. The purpose of this article is to review all of the innovations, starting from fetal life, that led to a change of strategy for single ventricle.Methods: Our literature review included all full articles published in English language on the Cochrane, MedLine, and Embase with references to "single ventricle" and "univentricular hearts", including the initial history of the treatments for this congenital heart defects as well as the innovations reported within the last decades.

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Duct Stenting in Duct-Dependent Systemic Blood Flow, Past, Present, and Future

Schranz

2024

Pediatr Cardiol

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Arterial duct stenting, pioneered in the early 1990s for newborns with a duct-dependent pulmonary and systemic circulation, has evolved significantly over the past decades. This progressive technique has led to the development of novel therapeutic strategies, including the Hybrid approach introduced three decades ago, and more recently, a complete transcatheter approach for treating newborns with hypoplastic left heart syndrome (HLHS). Subsequently, the transcatheter method has been extended to bi-ventricular lesions and patients with pulmonary hypertension, establishing a reverse Potts-shunt pathophysiology. Considering current experiences, this review aims to assess the strengths, weaknesses, and complications associated with ductal stenting, which represents a critical component of these complex treatment strategies. Despite advancements, the mortality rate of Norwood and Hybrid stage-1 procedures has plateaued, underscoring the importance of enhancing the quality of life of affected patients as the primary therapeutic goal. The prerequisite is a gentle, almost atraumatic medicine, particularly during the newborn period. It is essential to recognize that both the Hybrid and total transcatheter approaches demand comparable experience to Norwood surgery. Successful outcomes hinge on much more than merely inserting a stent into the duct; they require meticulous attention to detail and comprehensive management strategies.

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Modified Microvascular Plug as a Flow Restrictor in Hypoplastic Left Heart Syndrome with Dysplastic Tricuspid and Pulmonary Valves

Cited by 15 publications

References 13 publications

Transcatheter Palliation With Pulmonary Artery Flow Restrictors in Neonates With Congenital Heart Disease: Feasibility, Outcomes, and Comparison With a Historical Hybrid Stage 1 Cohort

Transcatheter Palliation With Pulmonary Artery Flow Restrictors in Neonates With Congenital Heart Disease: Feasibility, Outcomes, and Comparison With a Historical Hybrid Stage 1 Cohort

Narrative review of single ventricle: where are we after 40 years?

Duct Stenting in Duct-Dependent Systemic Blood Flow, Past, Present, and Future

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