Stenting of Lesions in Patent Ductus Arteriosus with Duct-Dependent Pulmonary Blood Flow

Alwi, Mazeni; Mood, Marhisham Che

doi:10.1016/j.iccl.2012.09.011

Cited by 18 publications

(23 citation statements)

References 33 publications

(35 reference statements)

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“…Careful follow-up is mandatory, because of early and unpredictable restenosis of the PDA stent putting the patient at risk of severe cyanosis and death. The improved outcomes described in more recent reports are due in part to the availability of flexible, low-profile stents designed for coronary artery use that can be delivered safely through a 4 to 5 French sheath [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiac Catheterisation Interventions in Neonates and Infants Less Than Three Months

Alakhfash¹,

Jelly²,

Almesned³

et al. 2020

Journal of the Saudi Heart Association

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Introduction Pediatric cardiac catheterization interventions become an established way of care for selected patients with congenital heart diseases. Cardiac catheterization for neonates and small infants can be challenging. The indications for diagnostic cardiac catheterization have decreased with the advent of advanced non-invasive imaging modalities. Patients and method Between June 2012 and July 2017 patients less than three months who had cardiac catheterization in two centers were reviewed Results During the study period, 174 patients underwent interventional cardiac catheterization,83.3% of them had CHD with two-ventricle circulation and 29 patients (16.7%) had single ventricle pathophysiology. Procedures include diagnostic cath, BAS, balloon pulmonary and aortic valvuloplasty, coarctation angioplasty, and stenting procedures. The vascular access depends upon the type of procedure. All except one had general anesthesia. ICU admission was required on 106 patients (62%). Patients were divided according to the type of cardiac lesion (single versus biventricular pathology) as well as according to the type of intervention (stenting and non-stenting procedures). Comparing these groups revealed that: stent procedures and procedures for patients with single ventricle pathologies were performed at an earlier age, with more contrast, fluoro and procedure time than for non-stent procedures and procedures for patients with biventricular pathologies. Complications include transient arrhythmias in most patients, perforation of the RVOT in one and lower limb hypoperfusion in 12 patients. ICU complications include low cardiac output symptoms (LCOS) in 10 (7%), and sepsis in 8. No intra-procedure mortality. The overall survival was 94%. Ten patients died, with one early and 9 late mortality. 60% of the dead patients had PDA stenting. Reintervention varies according to the patient's diagnosis. Conclusion Cardiac catheterization intervention an important modality in the management of neonates and infants with critical CHD. Well planned procedures and team expertise are essential. Stenting procedures and procedures for patients with single ventricles carries higher morbidity and mortality.

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Section: Introductionmentioning

confidence: 99%

Cardiac Catheterisation Interventions in Neonates and Infants Less Than Three Months

Alakhfash¹,

Jelly²,

Almesned³

et al. 2020

Journal of the Saudi Heart Association

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show abstract

“…Because the PDA is inherently variable in its systemic arterial origin, in its insertion onto the pulmonary arteries, and in its diameter and tortuosity, a range of access points have been employed to facilitate transcatheter stenting. Among other approaches, both the femoral artery (FA) and carotid artery (CA) access approaches have been utilized for PDA stenting . Some variations of PDA and aortic arch anatomy can pose particular challenges when approached from the FA—notably when the PDA has a superior–inferior orientation and when the PDA arises from the underside of the aortic arch.…”

Section: Introductionmentioning

confidence: 99%

“…Among other approaches, both the femoral artery (FA) and carotid artery (CA) access approaches have been utilized for PDA stenting. [7][8][9] Some variations of PDA and aortic arch anatomy can pose particular challenges when approached from the FA-notably when the PDA has a superior-inferior orientation and when the PDA arises from the underside of the aortic arch. Hence, CA and even axillary artery (AA) access have been employed to place the PDA stent in some infants with this PDA anatomy.…”

mentioning

confidence: 99%

Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal‐dependent pulmonary blood flow: A multicenter study from the congenital catheterization research collaborative

Bauser‐Heaton

Qureshi

Goldstein

et al. 2019

Cathet Cardio Intervent

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Background Carotid artery (CA) and axillary artery (AA) access are increasingly used for transcatheter stenting of the patent ductus arteriosus (PDA), although reports are limited. Methods The Congenital Catheterization Research Collaborative (CCRC) reviewed multicenter data from infants who underwent PDA stenting via the CA or AA approach from 2008 to 2017, and compared outcomes to those of infants undergoing PDA stenting via the femoral artery (FA) approach. Post‐procedure ultrasound (US) imaging was reviewed. Results Forty‐nine infants underwent PDA stenting from the CA (n = 43) or AA (n = 6) approach, compared with 55 infants who underwent PDA stenting from the FA approach. The PDA was the sole pulmonary blood flow (PBF) source in 61% of infants in the CA/AA cohort, compared with 33% of the FA cohort (p < .01). Ductal tortuosity for CA/AA cohort was Type I (straight) in 10 (20%), Type II (one turn) in 17 (35%), and Type III (multiple turns) in 22 (45%) infants and reflected a greater degree of tortuosity when compared to the FA cohort (p < .01). In 17 infants with CA/AA approach, the “flip technique” was used, and was associated with shorter procedure times for highly tortuous PDA (Type III) patients. Rates of procedural complications were similar across access sites. Most common complications were access site injury (thrombus or bleeding) and stent malposition. No complications were specifically related to the “flip technique.” Conclusions Use of CA and AA approach for PDA stenting was found to be more commonly employed in sole source PBF and highly tortuous PDAs. Procedural modifications such as the “flip technique” may lead to shorter procedure times. CA and AA approaches are associated with a similar burden of procedural or late complications. Post‐procedural surveillance of the CA and AA is suggested, given the incidence of vascular findings on US.

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“…In fact, the best results are obtained in diseases where the arterial duct is short and less tortuous, such as in pulmonary atresia with an intact ventricular septum and critical pulmonary stenosis. 14 In addition to the favourable arterial duct anatomy, stent delivery in a prograde venous approach after balloon pulmonary valvuloplasty gives one more advantage for easier positioning. On top of this, ductal stenting is a preferable choice in pulmonary atresia with intact ventricular septum, where ductal patency is needed for a medium period of time in order to decide whether biventricular repair is achieved or subsequent therapy is needed.…”

Section: Discussionmentioning

confidence: 99%

Ductal stenting to improve pulmonary blood flow in pulmonary atresia with intact ventricular septum and critical pulmonary stenosis after balloon valvuloplasty

et al. 2019

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Objective:To assess the feasibility, safety, and efficiency of ductal stenting in pulmonary atresia with intact ventricular septum or critical pulmonary stenosis after balloon pulmonary valvuloplasty.Background:Ductal stenting in pulmonary atresia with intact ventricular septum is a re-emerging and promising technique. There is little data available on its outcomes after establishing prograde pulmonary blood flow.Methods:We retrospectively reviewed all neonates with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis who underwent ductal stenting after balloon valvuloplasty. Ductal stenting was performed either in the same setting (group A) or a few days later after balloon valvuloplasty (group B). We compared the two groups.Results:Eighteen coronary stents were transvenously delivered and successfully deployed in 18 newborns. There was no procedure-related mortality. The median hospital stay post-intervention was 6 days with a mean discharge oxygen saturation of 94%. Group A had a shorter overall hospital stay with a shorter overall time of irradiation but with a longer overall procedural time. On a follow-up of 18 months, no re-intervention for stent failure or overflow was undertaken. The median stent patency based on echocardiography was 12 months.Conclusion:Stenting the arterial duct in pulmonary atresia with intact ventricular septum or critical pulmonary stenosis is a feasible, safe, and efficient technique. It avoids surgery or long hospital stay with prostaglandin infusion. The minimal 6 months stent longevity provides a period of time long enough to decide whether the right ventricular diastolic function is normalised or Glenn surgery is still needed.

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Stenting of Lesions in Patent Ductus Arteriosus with Duct-Dependent Pulmonary Blood Flow

Cited by 18 publications

References 33 publications

Cardiac Catheterisation Interventions in Neonates and Infants Less Than Three Months

Cardiac Catheterisation Interventions in Neonates and Infants Less Than Three Months

Use of carotid and axillary artery approach for stenting the patent ductus arteriosus in infants with ductal‐dependent pulmonary blood flow: A multicenter study from the congenital catheterization research collaborative

Ductal stenting to improve pulmonary blood flow in pulmonary atresia with intact ventricular septum and critical pulmonary stenosis after balloon valvuloplasty

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