Staged rehabilitation of ductal origin of the left pulmonary artery in an infant fallot's tetralogy

Peirone, Alejandro; Lee, Kyong‐Jin; Yoo, Shi‐Joon; Musewe, Norman N.; Smallhorn, Jeffrey; Benson, Lee

doi:10.1002/ccd.10538

Cited by 10 publications

(4 citation statements)

References 17 publications

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“…Early surgical intervention for UAPA was suggested to potentially preserve the affected lung vasculature and prevent morbidity and mortality in recent small series. [16][17][18][19] At the Seoul National University Children's Hospital, aggressive surgical and transcatheter interventions were performed in patients with UAPA, if possible, regardless of the initial symptoms. The purpose of this study was to evaluate the efficacy of early rehabilitation of the remnant PA, factors affecting PA growth, and clinical outcomes.…”

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confidence: 99%

Rehabilitation of pulmonary artery in congenital unilateral absence of intrapericardial pulmonary artery

Kim

Ban

Bae

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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confidence: 99%

Rehabilitation of pulmonary artery in congenital unilateral absence of intrapericardial pulmonary artery

Kim

Ban

Bae

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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“…To salvage the isolated obstruction of the LPA, a Blalock-Taussig shunt is an option, 10 and stent implantation for the DA is another. 3 However, both procedures are invasive and could result in excessive pulmonary blood flow in a child with high pulmonary blood flow disease. Although several studies have reported the usefulness of stent implantation for the DA, it can be fatal, because acute in-stent obstruction frequently occurs.…”

Section: Discussionmentioning

confidence: 99%

“…Although several studies have reported the usefulness of stent implantation for the DA, it can be fatal, because acute in-stent obstruction frequently occurs. [1][2][3][4][5][6] Furthermore, the stent can interfere with subsequent surgical repair and require removal. Although BA has the potential risk of rupture or re-stenosis of the DA, it is less invasive than stent implantation and will not affect any subsequent surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Both balloon angioplasty (BA) and stent implantation can potentially result in re-stenosis or complete occlusion. 3,6 Furthermore, stent implantation could interfere with any subsequent surgery. We report our experience using a combination of BA for the stenotic DA and nitrogen inhalation therapy in an infant with complex congenital heart disease with non-confluent unbalanced pulmonary blood flow.…”

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confidence: 99%

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Balloon Angioplasty for Ductus Arteriosus in Infant With Ductal Origin of the Left Pulmonary Artery Combination With Nitrogen Inhalation Therapy

Sugiyama

Hoshiai

Naito

et al. 2007

Circ J

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solated pulmonary artery is occasionally seen in children with tetralogy of Fallot, pulmonary atresia with ventricular septal defect, heterotaxia syndromes, and truncus arteriosus. In such cases, stenosis or occlusion of the proximal portion of the isolated pulmonary artery frequently occurs because of constriction by the ductal tissue, so management of the stenosis is a critical concern.Clinical experience of catheter intervention for the ductus arteriosus (DA) remain limited 1-5 and the indications are controversial. Both balloon angioplasty (BA) and stent implantation can potentially result in re-stenosis or complete occlusion. 3,6 Furthermore, stent implantation could interfere with any subsequent surgery. We report our experience using a combination of BA for the stenotic DA and nitrogen inhalation therapy in an infant with complex congenital heart disease with non-confluent unbalanced pulmonary blood flow. Case ReportA 2-day-old baby was referred because of heart murmur and cyanosis. He was diagnosed as having truncus arteriosus (Van Praagh type A3; ductal origin of the left pulmonary artery (LPA)). Color Doppler echocardiography showed trace blood flow in the DA. High-dose prostaglandin E1-CD was intravenously administered to open the DA, butCirculation Journal Vol.71, March 2007 was not effective. At the age of 8 days, catheter examination and angiography were performed after his parents gave written informed consent.The infant was heparinized during the procedure (150 IU/kg). Aortography revealed an extremely narrow DA, which connected to the LPA, and the distal pulmonary artery tree could not be demonstrated (Fig 1a). To salvage the LPA, a J-type guide wire (0.035 Radifocus, Terumo, Japan) was advanced with slight resistance through a 4Fr Judkins left-type catheter and the stenosis was dilated using a balloon catheter (4×20 mm, Power Flex P3, Cordis Corp, FL, USA) at 6 atm. The balloon size was 150% of the reference diameter of the distal LPA. The minimal lumen diameter (MLD) significantly increased from 0.7 mm to 2.7 mm after the procedure (Fig 1b). Oxygen saturation in the systemic artery slightly increased from 90% to 92% on room air and the left-to-right pulmonary perfusion ratio on the pulmonary perfusion scan significantly increased from 0.03 to 0.15. During the follow-up, the cardiothoracic ratio (CTR) on chest X-ray increased from 0.59 to 0.63 and tachypnea of 50 /min developed gradually with physiological dropping of pulmonary arterial resistance and increased pulmonary blood flow. Therefore, nitrogen gas was administered through a nasal positive airway pressure inhalation system at approximately 0.18 of the inspiratory oxygen fraction. Immediately after initiation of hypoxic therapy, the arterial systolic pressure dramatically increased from 46 mmHg to 68 mmHg and urination also increased. Three weeks after the procedure, echocardiography revealed diminished left pulmonary blood flow again, so at the age of 33 days, repeat BA was performed as before. The MLD increased from 1.8 mm to 2.7 mm...

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Neonatal rhabdomyoma causing right ventricular inflow obstruction with duct‐dependent pulmonary blood flow: Successful stenting of PDA

Ilina

Jaeggi

Lee

2007

Cathet Cardio Intervent

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We describe an infant with the antenatal diagnosis of a large intracardiac rhabdomyoma causing tricuspid inflow obstruction. Postnatal cyanosis and arterial hypoxemia prompted commencement of intravenous prostaglandin E1 with immediate improvement in saturations. Clinical and genetic testing confirmed diagnosis of tuberous sclerosis. To secure ductal patency, two tandem coronary stents were implanted via an antegrade approach. Several episodes of long RP atrio-ventricular re-entrant tachycardia were observed. At 7½ months of age, the tumor was no longer obstructive to tricuspid inflow, ductal flow was highly restrictive and there was no recurrence of supraventricular tachycardia. ' 2007 Wiley-Liss, Inc.Key words: rhabdomyoma; tricuspid inflow obstruction; stent implantation; patent arterial duct; SVT CASE REPORT A female baby was born at term by vaginal delivery to a healthy 33-year-old mother who had one previous miscarriage. There was no family history of tuberous sclerosis (TS). Surveillance obstetrical ultrasound scans at 12, 18, and 22 weeks gestation were normal. At 36 weeks gestation, polyhydramnios, and a cardiac mass were detected. The fetal echocardiogram revealed multiple homogeneous well circumscribed tumors within the myocardial wall. The largest mass was attached to the tricuspid valve and measured 1.3 3 1 cm 2 ( Fig. 1A and B). There was tricuspid inflow acceleration to a peak velocity of 126 cm/s and abnormal inferior and superior vena caval Doppler flow patterns with increased A-wave reversal consistent with right ventricular inflow obstruction. Rhabdomyomas associated with TS were quoted as most likely diagnosis.No resuscitation was required at birth. Birth weight was 2.8 kg. Hyperoxia test at 1 hr of age demonstrated a preductal PaO 2 of 80 mmHg. At 3 hr of age, cyanosis with a transcutaneous oxygen saturation of 82% in room air prompted commencement of prostaglandin E1 (alprostadil) infusion with immediate improvement in oxygen saturations to 95%. Neonatal examination was unremarkable except an ejection systolic murmur at the left upper sternal border. No dysmorphic features or skin lesions were found.Electrocardiogram on admission demonstrated atrial enlargement, right ventricular hypertrophy, and no preexcitation. The postnatal echocardiogram confirmed presence of multiple rhabdomyomas in the right and left ventricular free wall, interventricular septum, and left atrial appendage. The largest tumor (Fig. 1C and D) was attached to the atrial surface of anterior tricuspid leaflet causing severe tricuspid inflow obstruction and right to left shunt across the patent foramen ovale. The rest of the cardiovascular anatomy was normal and there was a patent ductus arteriosus (PDA).

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Staged rehabilitation of ductal origin of the left pulmonary artery in an infant fallot's tetralogy

Cited by 10 publications

References 17 publications

Rehabilitation of pulmonary artery in congenital unilateral absence of intrapericardial pulmonary artery

Rehabilitation of pulmonary artery in congenital unilateral absence of intrapericardial pulmonary artery

Balloon Angioplasty for Ductus Arteriosus in Infant With Ductal Origin of the Left Pulmonary Artery Combination With Nitrogen Inhalation Therapy

Neonatal rhabdomyoma causing right ventricular inflow obstruction with duct‐dependent pulmonary blood flow: Successful stenting of PDA

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