Stent angioplasty of narrowed right ventricular outflow conduits and pulmonary arteries consistently reduces right ventricular systolic pressures and delays subsequent surgeries

Abstract

ObjectivesNarrowed right ventricular (RV) outflow conduits and pulmonary arteries (PA) increase RV pressures and warrant interventions. Stent angioplasty is an alternative to more morbid redo-surgery in developing countries. We evaluate the efficacy and safety of stenting and assess need for redo-surgical reinterventions on midterm follow-up after stent angioplasty.MethodsPatients who underwent conduit, main PA and bilateral branch PA stenting for elevated RV pressures were analyzed retrospectively. Success was defined as 20% reduction in RV pressures or RV-aortic pressure ratio; 50% reduction in gradients or 50% increase of luminal diameter. Procedural results, complications and need for redo surgeries on follow-up were assessed.ResultsAmong 60 patients aged 1–46 years, 57 were post-operative patients, who needed stenting at a median period of 48 months after surgery. Stenting succeeded in 98% and reduced RV pressures from 105.42 ± 28.39 mmHg to 54.46 ± 16.89 mmHg. Direct major procedural complications in five (8%) patients included procedural failure in one, stent migration in three and lung hemorrhage in one. None of the stented conduits needed a surgical change on a follow-up ranging 3–120 months. Following bilateral PA stenting in twenty-four patients, only two needed a repeat open-heart surgery during follow-up ranging 3–108 months. Catheter reinterventions on follow-up included elective percutaneous pulmonary valve implantation in nine patients and stent redilation in seven patients.ConclusionsStent angioplasty was safe and effective. Surgery was postponed in all stenosed conduits. Elective redilation of stents after bilateral PA stenting may be needed for somatic growth; but open-heart repeat surgeries can be avoided in a majority.

Self-Expandable Stents in Vascular Stenosis of Moderate to Large-Sized Vessels in Congenital Heart Disease: Early and Intermediate-Term Results

“…Many interventional types of catheterization have been introduced and accepted as alternative to surgery in intravascular stenosis in several congenital heart diseases 5)6)7)8). Balloon dilation is a useful option for the management of intravascular stenosis; however, restenosis can frequently occur immediately or later following balloon dilation because of external compression, non-dilatable fibrotic lesion, or enhanced vessel elasticity.…”

Transcatheter surgery of residual right ventricular outflow tract stenosis

“…С 1987г для лечения обструктивной патологии ЛА начали применять стент "Palmaz", разработанный компанией "Johnson & Johnson Interventional Systems" (США). Данный метод продемонстрировал хорошие непосредственные результаты: было отмечено снижение гемодинамической перегрузки ПЖ, уменьшение систолического градиента давления, достаточное увеличение просвета стентированного участка [11].…”