Stenting and overdilating small Gore‐Tex vascular grafts in complex congenital heart disease

Abstract

Background: Gore-Tex ® grafts are integral in the management of congenital heart disease. Issues

Surgically placed radiopaque markers: Proof‐of‐concept of a novel technique to facilitate percutaneous interventions in neonates and infants

“…In this study, we gave priority to marking central shunts on hypoplastic pulmonary arteries that would be recruited through repeated interventions 17,18 ; or shunts that will necessitate adapting to somatic growth to lengthen palliation and delay the time to corrective surgery, respectively. 4,19 Catheterizations of infants with marked shunts were characterized by easy access to the pulmonary arteries-reflected in all cases by the brief probing times and accurate stent positioning. In the hybrid setting, stenting of the systemic duct was facilitated by the marker at its pulmonary origin, which allowed use of a short 4F sheath for transvenous antegrade delivery, followed by proper stent placement.…”

“…Avoiding long sheaths for stent delivery is particularly beneficial for transvenous access via the heart of young infants because that is usually better tolerated hemodynamically. 4 In addition, our marker strategy also enabled us to dispense with the use of arterial sheaths and aortic catheters that would otherwise be used for control angiographies during stent placement, 10 thus avoiding the vascular complications that are so common in early childhood. 20,21 Neonates and infants of low body weight are at particular risk for periprocedural complications during cardiac catheterization.…”

“…Stenting the arterial duct during hybrid palliation, interventions in the pulmonary arteries through a systemic-to-pulmonary artery shunt, or stenting the shunt itself are examples of such procedures. [1][2][3][4] Since these procedures involve small shunts with diameters usually between 3.0 and 4.5 mm (which often branch off at a sharp angle from the aorta), probing can be difficult, especially when done in urgent situations. [5][6][7][8][9] In the context of hybrid palliation, bilateral pulmonary artery bandings are applied followed by stenting the arterial duct to ensure systemic circulation in congenital cardiac lesions with severe stenosis or an interrupted aorta.…”

Expandable Valves, Annuloplasty Rings, Shunts, and Bands for Growing Children

“…balloon dilate and/or stent ePTFE grafts by as much as 26À28% of their original diameter without complication, thereby allowing for increased pulmonary blood flow commensurate with growth. 28,29 Nonetheless, this only translates to an approximately 1 mm increase in shunt diameter.…”

Promotion of right ventricular outflow tract reconstruction using a novel cardiac patch incorporated with hypoxia-pretreated urine-derived stem cells

“…Currently available commercial patches include biological and synthetic materials such as knitted polyethylene terephthalate, expanded polytetrafluoroethylene, glutaraldehyde-fixed bovine pericardium, etc. [ [4] , [5] , [6] , [7] ] The electrical conductivity and mechanical properties of such materials do not match with those of normal myocardium, which may lead to an increased risk for arrhythmia, heart failure, and even sudden cardiac death [ [8] , [9] , [10] , [11] , [12] ]. For pediatric patients, the lack of growth potential of such patches is also an important issue.…”