Stent implantation of the arterial duct in newborns with duct-dependent circulation

Schneider, Martin; Zartner, Peter; Sidiropoulos, A; Konertz, W; Hausdorf, G.

doi:10.1053/euhj.1998.0977

Cited by 124 publications

(114 citation statements)

References 8 publications

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“…Ductal stenting has become the preferred option because of its advantages: no need for surgery, shorter hospital stays, and lower risk of branch-PA distortion, chylothorax, and phrenic and vagal paralysis. 8,9 The rapid closure achieved with ductal stenting also eliminates the need for further interventions, especially in patients with hypoplasia of the RV who are candidates for biventricular repair. In our hospital, we prefer ductal stenting as first-line treatment in neonates who have critical pulmonary stenosis.…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Transcatheter Closure of Central Aortopulmonary Shunts: One with an Amplatzer Duct Occluder II and One with an Amplatzer Vascular Plug I

Çelebi¹,

Yücel²,

Ballı³

et al. 2016

Texas Heart Institute Journal

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1 Overcirculation, thrombosis, and stenosis of the shunt are the main postoperative sequelae that necessitate urgent reintervention.2 Percutaneous transcatheter interventions on aortopulmonary shunts can eliminate the need for reoperation and substantially decrease postoperative morbidity and mortality rates. We report 2 pediatric cases of overcirculation caused by central aortopulmonary shunts, and our use of 2 different AmplAtzer devices to occlude them. Case Reports Patient 1A 13-day-old female infant with cyanosis was referred to our hospital. Echocardiograms revealed a nearly atretic pulmonary valve (PV), a mildly hypoplastic right ventricle (RV), a tricuspid annulus 9.5 mm in diameter (Z score, -1.84), and moderate tricuspid regurgitation. The patient was started on prostaglandin E 1 therapy, and emergency cardiac catheterization was undertaken. After predilating the PV with use of a 4-mm coronary balloon, we performed pulmonary balloon valvuloplasty with use of an 8-mm × 2-cm Tyshak ® Percutaneous Transluminal Valvuloplasty balloon (NuMED, Inc.; Hopkinton, NY). Thereafter, the patient's RV pressure decreased from 110 to 42 mmHg, and PV regurgitation was mild. We discontinued prostaglandin E 1 infusion and waited to see if the patient's oxygen saturation decreased; it remained at 80%, so infusion was ended. However, after 4 hours, we had to restart the infusion immediately, to undertake ductus stenting. When ductal patency could not be reestablished, we performed an emergency central aortopulmonary shunt operation with use of a 3.5-mm polytetrafluoroethylene (PTFE) graft. The patient's oxygen saturation increased from 64% to 88%, and she was discharged from the hospital on postoperative day 7.

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Section: Discussionmentioning

confidence: 99%

Two Cases of Transcatheter Closure of Central Aortopulmonary Shunts: One with an Amplatzer Duct Occluder II and One with an Amplatzer Vascular Plug I

Çelebi¹,

Yücel²,

Ballı³

et al. 2016

Texas Heart Institute Journal

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“…(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) The majority of patients underwent patent ductus arteriosus (PDA) stenting at an early age, usually shortly after birth, with weights ranging between 1.5 -4.5kg.…”

Section: Immediate Outcomes Of Pda Stentingmentioning

confidence: 99%

Stenting the arterial duct: Practical aspects and review of outcomes

Buys

Brown

Greig

2017

SAHJ

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Maintaining ductus arteriosus patency by the percutaneous placement of coronary artery stents provides an alternative to surgical systemic-to-pulmonary artery shunts. This maintains pulmonary blood flow and serves as a temporary bridge towards later surgical repair. Since the first report by Gibbs, et al. in 1992, the success and outcome of ductal stenting have improved due to advances in technique and equipment. This is now considered an acceptable option for these patients in many centres. OUTCOMES OF DUCTUS ARTERIOSUS STENTING: A REVIEW OF CURRENT LITERATURE Immediate outcomes of PDA stentingA detailed description of the immediate outcomes of PDA stenting can be viewed in Table 1. (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) The majority of patients underwent patent ductus arteriosus (PDA) stenting at an early age, usually shortly after birth, with weights ranging between 1.5 -4.5kg.Procedural success was good and stent placement was successful in 80 to 100% of the cases. The effectiveness of the procedure is highlighted by the fact that all studies have shown a significant improvement in arterial saturations after stent placement. Some cases have required more than 1 stent in an attempt to ensure adequate coverage of the entire ductal length. Reported periprocedural complication rates were low: major complications included stent migration, acute thrombosis and permanent femoral vessel damage. Very few immediate deaths were directly related to

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“…Important shortcomings exist with each of the current palliative options. [5][6][7][8][9][10][11][12] Continuous prostaglandin E1 infusion involves prolonged intravenous access and hospitalization, high drug cost, and medical complications. Balloon dilation of the arterial duct has a high rate of reocclusion.…”

Section: Clinical Perspective P 2085mentioning

confidence: 99%

“…8 More effective than balloon dilatation, ductal stenting with a bare metal stent (BMS) has been reported in a variety of conditions with duct-dependent systemic and pulmonary blood flows. 6,9,12 The initial technical challenges of ductal stenting have been overcome by the use of coronary stents with a low profile and easy deliverability. 6 Although acutely effective, the main shortcoming of ductal stenting is in-stent stenosis secondary to neointimal proliferation, resulting in progressive obstruction and necessitating premature reintervention.…”

Section: Clinical Perspective P 2085mentioning

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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Stent implantation of the arterial duct in newborns with duct-dependent circulation

Abstract: In patients with cyanotic congenital heart disease stenting of the arterial duct is an effective alternative to surgical aorto-pulmonary shunts.

Cited by 124 publications

References 8 publications

Two Cases of Transcatheter Closure of Central Aortopulmonary Shunts: One with an Amplatzer Duct Occluder II and One with an Amplatzer Vascular Plug I

Two Cases of Transcatheter Closure of Central Aortopulmonary Shunts: One with an Amplatzer Duct Occluder II and One with an Amplatzer Vascular Plug I

Stenting the arterial duct: Practical aspects and review of outcomes

Rapamycin-Eluting Stents in the Arterial Duct

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