Stenting of the left pulmonary artery after palliation of hypoplastic left heart syndrome

Noonan, Patrick; Kudumula, Vikram; Anderson, Ben; Ramchandani, Bharat; Miller, Paul A.; Dhillon, Rami; Mehta, Chetan; Stümper, Oliver

doi:10.1002/ccd.26450

Cited by 28 publications

(20 citation statements)

References 22 publications

(26 reference statements)

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“…The advantage of our strategy is supported by our not observing severe LPA stenosis requiring surgical and interventional treatment in any case. That is in contrast to several other publications in which a different surgical strategy was used [7,26,28]. Therefore, from a surgical point of view, we could suggest that LPA augmentation prevents LPA stenosis.…”

Section: Surgical Findingscontrasting

confidence: 86%

“…In the literature, stenting of the LPA after Norwood or Fontan palliation has been recommended as interventional treatment to increase the blood flow in the LPA [26]. But the use of stents to repair LPA hypoplasia or stenosis is often associated with complications during growth such as restenosis requiring redilation or surgical stent removal including surgical reconstruction of the vessel [26,27]. The advantage of our strategy is supported by our not observing severe LPA stenosis requiring surgical and interventional treatment in any case.…”

Section: Surgical Findingsmentioning

confidence: 86%

“…Generally, LPA hypoplasia and stenosis are wellrecognized complications after surgical palliation of HLHS patients [24,25]. In the literature, stenting of the LPA after Norwood or Fontan palliation has been recommended as interventional treatment to increase the blood flow in the LPA [26]. But the use of stents to repair LPA hypoplasia or stenosis is often associated with complications during growth such as restenosis requiring redilation or surgical stent removal including surgical reconstruction of the vessel [26,27].…”

Section: Surgical Findingsmentioning

confidence: 99%

See 2 more Smart Citations

Improved Lung Perfusion After Left Pulmonary Artery Patch Enlargement During the Norwood Operation

Ravesh

Scheewe

Attmann

et al. 2018

The Annals of Thoracic Surgery

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These first magnetic resonance imaging data show that HLHS patients after LPA patch enlargement during the modified Norwood procedure have significantly higher LPA cross-sectional areas and show improved lung perfusion and shorter overall procedure time as compared with LPA patching during second stage (hemi-Fontan). Therefore, this promising surgical technique may improve blood flow dynamics of the Fontan circulation in the long run.

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Section: Surgical Findingscontrasting

confidence: 86%

Section: Surgical Findingsmentioning

confidence: 86%

Section: Surgical Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Improved Lung Perfusion After Left Pulmonary Artery Patch Enlargement During the Norwood Operation

Ravesh

Scheewe

Attmann

et al. 2018

The Annals of Thoracic Surgery

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“…Such lesions require addressing by interventional stenting procedures of the branch pulmonary arteries. [11]…”

Section: Catheter Hemodynamic and Angiographic Assessmentmentioning

confidence: 99%

Catheter hemodynamic assessment of the univentricular circulation

Stümper

Penford

2017

Ann Pediatr Card

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Children with very complex congenital heart disease not amenable to biventricular repair are increasingly being considered for a palliative univentricular care pathway. This involves a staged surgical approach culminating in the Fontan circulation with passive pulmonary blood flow and added resistances. The catheter based hemodynamic assessment at all three stages of this palliation is described in detail. Frequent pitfalls, inherent limitations and potential errors are discussed and clinical examples are illustrated.

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“…The postsurgical flow distribution to the lungs is difficult to predict, and various surgical or endovascular interventions may be required to address specific circulatory issues. For example, endovascular angioplasty may be required to dilate hypoplastic pulmonary arteries in an effort to remove even discrete stenosis and optimize pulmonary flow distribution (Noonan et al ., ; Schwartz et al ., ). Furthermore, assuring equal distribution of hepatic blood flow to both lungs is important to avoid pulmonary arteriovenous malformations that decrease systemic oxygenation (Duncan & Desai, ).…”

Section: Introductionmentioning

confidence: 97%

Simulation of aortopulmonary collateral flow in Fontan patients for use in prediction of interventional outcomes

Frieberg

Sjöberg

Revstedt

et al. 2017

Clin Physio Funct Imaging

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4D-flow; cardiac magnetic resonance; patientspecific simulation; prediction of invasive interventions; total cavopulmonary connection Purpose Patients with complex congenital heart disease may need to be converted to a Fontan circulation with systemic venous return surgically connected to the pulmonary circulation. These patients frequently form aortopulmonary collaterals (APC), that is arterial inflows to the pulmonary artery vascular tree. The aim of this study was to develop a method to calculate the effect of APC on the pulmonary flow distribution based on magnetic resonance imaging (MRI) measurements and computational fluid dynamics simulations in order to enable prediction of interventional outcomes in Fontan patients. Methods Patient-specific models of 11 patients were constructed in a 3D-design software based on MRI segmentations. APC flow was quantified as the difference between pulmonary venous flow and pulmonary artery flow, measured by MRI. A method was developed to include the modulating effect of the APC flow by calculating the patient-specific relative pulmonary vascular resistance. Simulations, including interventions with a Y-graft replacement and a stent dilatation, were validated against MRI results. Results The bias between simulated and MRI-measured fraction of blood to the left lung was 2Á9 AE 5Á3%. Including the effects of the APC flow in the simulation (n = 6) reduced simulation error from 9Á8 AE 7Á0% to 5Á2 AE 6Á3%. Preliminary findings in two patients show that the effect of surgical and catheter interventions could be predicted using the demonstrated methods. Conclusions The work demonstrates a novel method to include APC flow in predictive simulations of Fontan hemodynamics. APC flow was found to have a significant contribution to the pulmonary flow distribution in Fontan patients.

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Stenting of the left pulmonary artery after palliation of hypoplastic left heart syndrome

Cited by 28 publications

References 22 publications

Improved Lung Perfusion After Left Pulmonary Artery Patch Enlargement During the Norwood Operation

Improved Lung Perfusion After Left Pulmonary Artery Patch Enlargement During the Norwood Operation

Catheter hemodynamic assessment of the univentricular circulation

Simulation of aortopulmonary collateral flow in Fontan patients for use in prediction of interventional outcomes

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