Pulmonary artery growth after arterial duct stenting in completely duct-dependent pulmonary circulation

Santoro, Giuseppe; Capozzi, Giovanbattista; Capogrosso, Cristina; Mahmoud, Heba Talat; Gaio, Gianpiero; Palladino, Maria Teresa; Russo, Maria Giovanna

doi:10.1136/heartjnl-2015-308493

Cited by 21 publications

(19 citation statements)

References 24 publications

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“…PA growth is associated with complex flow structures observed in the PAs(Fang et al, 2014;Santoro et al, 2016;Tuchscherer et al, 2007). Our results captured complex swirling flow structures for all shunt configurations and sizes (Figures 2 to 5).…”

supporting

confidence: 65%

Hemodynamics of patient-specific aorta-pulmonary shunt configurations

Pişkin

Altin

Yıldız

et al. 2017

Journal of Biomechanics

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Optimal hemodynamics in aorta-pulmonary shunt reconstruction is essential for improved post-operative recovery of the newborn congenital heart disease patient. However, prior to in vivo execution, the prediction of post-operative hemodynamics is extremely challenging due to the interplay of multiple confounding physiological factors. It is hypothesized that the post-operative performance of the surgical shunt can be predicted through computational blood flow simulations that consider patient size, shunt configuration, cardiac output and the complex three-dimensional disease anatomy. Utilizing only the routine patient-specific pre-surgery clinical data sets, we demonstrated an intelligent decision-making process for a real patient having pulmonary artery atresia and ventricular septal defect. For this patient, a total of 12 customized candidate shunt configurations are contemplated and reconstructed virtually using a sketch-based computer-aided anatomical editing tool. Candidate shunt configurations are evaluated based on the parameters that are computed from the flow simulations, which include 3D flow complexity, outlet flow splits, shunt patency, coronary perfusion and energy loss. Our results showed that the modified Blalock-Taussig (mBT) shunt has 12% higher right pulmonary artery (RPA) and 40% lower left pulmonary artery (LPA) flow compared to the central shunt configuration. Also, the RPA flow regime is distinct from the LPA, creating an uneven flow split at the pulmonary arteries. For all three shunt sizes, right mBT innominate and central configurations cause higher pulmonary artery (PA) flow and lower coronary artery pressure than right and left mBT subclavian configurations. While there is a trade-off between energy loss, flow split and coronary artery pressure, overall, the mBT shunts provide sufficient PA perfusion with higher coronary artery pressures and could be preferred for similar patients having PA overflow risk. Central shunts would be preferred otherwise particularly for cases with very low PA overflow risk.

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supporting

confidence: 65%

Hemodynamics of patient-specific aorta-pulmonary shunt configurations

Pişkin

Altin

Yıldız

et al. 2017

Journal of Biomechanics

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“…[1][2][3] It provides a secure source of pulmonary blood flow while avoiding a surgical procedure and its associated comorbidities. 4,5 It also has the advantage of promoting branch pulmonary artery growth and may provide a more balanced pulmonary vasculature. However, the variations in origin, orientation, and morphology of the ductus arteriosus, commonly present with pulmonary valve lesions, may present a significant challenge for the interventional cardiologist and necessitate the need for access other than the femoral artery.…”

Section: Introductionmentioning

confidence: 99%

“…We had no procedure-related deaths although two patients later died of causes relating to their underlying cardiac condition (unrelated to the patency of the ductal stent). The median (IQR) follow up duration is 4(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) months. To date, one patient with ductal stenting via an axillary approach has required balloon angioplasty for stent narrowing.…”

mentioning

confidence: 99%

Percutaneous axillary artery approach for ductal stenting in critical right ventricular outflow tract lesions in the neonatal period

Breatnach

Aggarwal

Al-Alawi

et al. 2019

Cathet Cardio Intervent

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Objectives We aimed to assess the experience using a percutaneous axillary artery approach for insertion of arterial ductal stents in patients with critical right ventricular outflow tract lesions at two tertiary pediatric cardiology centers. Background Patent ductus arteriosus stenting is an accepted palliative alternative to BT shunts for neonates with critical right heart lesions. Access to tortuous ductus' may be challenging via the femoral artery, whereas the carotid artery presents a low risk of stroke. Recently, the axillary artery has been utilized for access in these patients. Methods We performed a retrospective review of neonates who underwent stent placement or angioplasty using percutaneous axillary artery approach at two tertiary care centers from October 2016 to November 2018. Medical records were reviewed to ascertain demographic, clinical, and outcome data. Results Axillary artery access was performed in 20 patients (16 primary ductal stents and 4 re‐interventions) at a median (IQR) procedural weight of 3.4 (3–3.9) kg. Median (IQR) procedural time was 110 (75–150) min. The median (IQR) ICU stay and intubation times were 14 (0–94) hr and 5 (0–40) hr, respectively. There were three access‐related vascular complications which were managed conservatively with no long‐term effects. Two patients subsequently died due to non‐procedure related causes. Conclusions Ductal stenting via a percutaneous axillary artery approach is a viable option in neonates with critical right ventricular outflow tract lesions. This approach provides an additional access site for PDA stenting which may be utilized in patients with vertical duct morphology.

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“…40 Technically, femoral artery access is necessary for retrograde crossing of the PDA, and stenting the ductus requires covering the full length of the ductus to avoid ductal stenosis distal to the edge of the stent. 44,45 The timing of the discontinuation of the prostaglandin E 2 infusion prior to ductal stenting is critical. The ductal size must be small enough to allow wedging of the stent in the duct such that the stent In rare circumstances emergent surgical intervention to create a shunt may be necessary if the stent cannot be deployed or hypoxemia persists despite stent deployment.…”

Section: Risk Assessment and Adverse Eve Ntsmentioning

confidence: 99%

Anesthesia for high‐risk procedures in the catheterization laboratory

Daaboul

DiNardo

Nasr

2019

Pediatric Anesthesia

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Summary Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus‐dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic‐related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.

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Pulmonary artery growth after arterial duct stenting in completely duct-dependent pulmonary circulation

Abstract: Percutaneous AD stenting was associated with significant and balanced PA growth in CHD with completely duct-dependent pulmonary circulation over a short-term follow-up. Thus, it may be considered as an alternative to surgical palliation in this subset of patients.

Cited by 21 publications

References 24 publications

Hemodynamics of patient-specific aorta-pulmonary shunt configurations

Hemodynamics of patient-specific aorta-pulmonary shunt configurations

Percutaneous axillary artery approach for ductal stenting in critical right ventricular outflow tract lesions in the neonatal period

Anesthesia for high‐risk procedures in the catheterization laboratory

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