Stenting of stenosed aortopulmonary collaterals and shunts for palliation of pulmonary atresia/ventricular septal defect

El‐Said, Howaida; Clapp, Sandra K.; Fagan, Thomas E.; Conwell, Jeffrey; Nihill, Michael R.

doi:10.1002/(sici)1522-726x(200004)49:4<430::aid-ccd18>3.0.co;2-c

Cited by 25 publications

(22 citation statements)

References 19 publications

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“…As most of these patients have surgery early in life, stenosis is generally dealt with by balloon angioplasty and, only in resistant cases or older patients do we resort to stent implantation. Balloon angioplasty may be unsuccessful unless high‐pressure balloons are used; occasionally cutting balloons are essential to score the vessel prior to achieving dilatation 3–8 …”

Section: Introductionmentioning

confidence: 99%

Timing, Frequency, and Results of Catheter Intervention Following Recruitment of Major Aortopulmonary Collaterals in Patients with Pulmonary Atresia and Ventricular Septal Defect

Giovanni¹

2004

J Interven Cardiology

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The condition of pulmonary atresia (PA), ventricular septal defect (VSD), and major aortopulmonary collaterals (MAPCAs) can have an extremely variable pulmonary blood supply and there are essentially three main anatomical subtypes, one with confluent native pulmonary arteries, one with intrapulmonary but nonconfluent pulmonary arteries, and one with MAPCAs and no native pulmonary arteries (1) Surgical repair can be very challenging and the results are further complicated by patchy vascular distribution to the lung parenchyma, multiple stenoses, progressive narrowing of the MAPCAs, and high pulmonary vascular resistance; despite these hurdles, surgical repair is being carried out with increasing frequency and success, but this is also creating a new population of patients who require a specific interventional strategy. These problems, some of which are not easily addressed surgically, can be helped by catheter intervention methods and the two approaches are complementary. Between 1989 and 2002, 164 patients had surgical recruitment of MAPCAs at Birmingham Children's Hospital with repair in 70%. On average, these patients require 2.3 catheter procedures up to the point of repair. The catheter interventions are technically demanding, time consuming, must be repeated, and require specific techniques due to the pathology of the vessels. The management of PA/VSD/MAPCAs involves a multidisciplinary team approach often requiring repeated procedures, especially for those at the worst end of the spectrum. A proactive approach is essential due to known disease progression. Considerable improvement in patients' quality of life and, hopefully, life expectancy makes this approach worthwhile.

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Section: Introductionmentioning

confidence: 99%

Timing, Frequency, and Results of Catheter Intervention Following Recruitment of Major Aortopulmonary Collaterals in Patients with Pulmonary Atresia and Ventricular Septal Defect

Giovanni¹

2004

J Interven Cardiology

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“…Several procedures are usually required before the definitive correction [1][2][3][4] . Dilation with a balloon catheter and use of stents in the pulmonary arteries may represent an important factor for the success of treatment [5][6][7] . The operative risk ranges from 0 to 20% depending on the number of shunts and thoracotomies before the definitive correction, which is only possible in 60 to 70% of patients 3,4 .…”

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confidence: 99%

Estudo angiográfico da circulação pulmonar na tetralogia de Fallot com atresia pulmonar

Santos¹,

Azevedo²

2005

Arq. Bras. Cardiol.

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Approximately 85% of the patients with tetralogy of Fallot associated with pulmonary atresia have anomalies of the pulmonary vascular tree. The pulmonary arteries are usually of a small caliber, often nonconfluent, and not connected to the right ventricle. In many cases, the proximal branches are stenotic, hypoplastic, or totally absent. The aortopulmonary collateral arteries are frequently present and may supply partially or almost totally the pulmonary blood flow.The treatment aims at establishing the confluence, normalizing the caliber and distribution of the pulmonary arteries, which may be obtained through the use of shunts and unifocalization of those vessels. Several procedures are usually required before the definitive correction [1][2][3][4] . Dilation with a balloon catheter and use of stents in the pulmonary arteries may represent an important factor for the success of treatment [5][6][7] . The operative risk ranges from 0 to 20% depending on the number of shunts and thoracotomies before the definitive correction, which is only possible in 60 to 70% of patients 3,4 . Recently, some researchers have adopted a radical approach with complete pulmonary arterial reconstruction, closure of the interventricular communication, and placement, in the neonatal period [8][9][10] , of a tube in the right ventricular outflow tract. Although the operative risk has been described as small, this approach requires more complex surgical techniques and experience of the surgical team, which are available only in certain centers 11,12 . This study aimed at demonstrating the importance of the angiographic study of the pulmonary blood supply in selecting patients with tetralogy of Fallot and pulmonary atresia for total or partial correction of that malformation. MethodsFrom 1980 to 2000, 82 patients with tetralogy of Fallot and pulmonary atresia were studied from the hemodynamic and cineangiocardiographic points of view. Twenty-six patients with pulmonary atresia associated with complex cardiac malformation (single atrium, single ventricle, single AV valve, and single outflow tract -pulmonary atresia) were excluded. The remaining 56 patients were between 20 days and 4 years of age, and their weights ranged from 1.7 kg to 10 kg. The pulmonary blood supply was studied by using the following methods: aortography with occlusion of the thoracic aorta with the Berman angiographic catheter 13 ConclusionThis type of approach enables the obtainment of information necessary for the correct clinicosurgical management of patients, due to the great complexity and extreme variability of the pulmonary blood supply in tetralogy of Fallot with pulmonary atresia.

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“…For those patients who are deemed poor surgical candidates yet remain palliated with a SPS indefinitely, the use of transcatheter stent implantation may prevent or postpone the need for surgical re‐intervention. Furthermore, stent implantation as a palliative procedure in these high‐risk surgical candidates has been shown to offer significant clinical improvement . Of note, not all patients will display overt clinical signs of shunt failure.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter stenting of the systemic‐to‐pulmonary artery shunt: A 7‐year experience from a single tertiary center

Vaughn

Moore

Mallula

et al. 2015

Cathet Cardio Intervent

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Stenting of stenosed aortopulmonary collaterals and shunts for palliation of pulmonary atresia/ventricular septal defect

Cited by 25 publications

References 19 publications

Timing, Frequency, and Results of Catheter Intervention Following Recruitment of Major Aortopulmonary Collaterals in Patients with Pulmonary Atresia and Ventricular Septal Defect

Timing, Frequency, and Results of Catheter Intervention Following Recruitment of Major Aortopulmonary Collaterals in Patients with Pulmonary Atresia and Ventricular Septal Defect

Estudo angiográfico da circulação pulmonar na tetralogia de Fallot com atresia pulmonar

Transcatheter stenting of the systemic‐to‐pulmonary artery shunt: A 7‐year experience from a single tertiary center

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