Transcatheter management of neonates with pulmonary atresia and intact ventricular septum

Siblini, Ghassan; Rao, P. Syamasundar; Singh, Gautam K.; Tinker, Kathy; Balfour, Ian

doi:10.1002/(sici)1097-0304(199712)42:4<395::aid-ccd11>3.0.co;2-j

Cited by 38 publications

(38 citation statements)

References 35 publications

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“…Stents were used to treat obstructions in pulmonary arteries, systemic and pulmonary veins, aorta and right ventricular outflow tract (RVOT) conduits [12][13][14][15][16][17][18]. They were also utilized to maintain patency of ductus arteriosus in pulmonary atresia and hypoplastic left heart syndrome [19][20][21], stenosed aortopulmonary collaterals [22,23] and surgically created but obstructed shunts [23,24]. Furthermore, stents are particularly helpful in accessing places inaccessible in conventional surgery.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Stent Therapy in Children: An Update

Sahu

Rao²

2012

Pediat Therapeut

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To address elastic recoil of vessel wall and intimal dissection that can follow balloon angioplasty, stents have been designed and these appear to produce more effective relief of obstruction. Of the two types of stents, namely, balloon expandable and self expandable, balloon expandable stents are most commonly used in children. The usefulness of stents in the management of vascular obstructive lesions not amenable to balloon angioplasty is well established and has been successfully used to treat branch pulmonary artery stenosis, coarctation of the aorta, stenotic right ventricular outflow tract conduits, obstructive lesions of the systemic and pulmonary veins and others. The techniques of implantation, indications, immediate and follow-up results and complications were reviewed. The stents have also been effectively used in keeping open naturally occurring or artificially created inter-circulatory connections and as adjuncts in hybrid procedures, but these have not been discussed in this review. Future directions include investigative work on biodegradable stents and growth stents to address issues related to increase in vessel size in infants and children, use of drug eluding stents to prevent neo-intimal proliferation to avoid pulmonary vein restenosis and refinement of stent technology in hybrid procedures such as neonatal palliation of hypoplastic left heart syndrome and transcatheter completion of Fontan procedure. The feasibility, safety and effectiveness stents in the pediatric population are demonstrated, although scrutiny of results of larger experience with longer follow-up is important.

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Section: Introductionmentioning

confidence: 99%

Transcatheter Stent Therapy in Children: An Update

Sahu

Rao²

2012

Pediat Therapeut

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“…Later on, the development of transcatheter pulmonary valve perforation techniques and balloon valvuloplasty have reduced the need for right ventricle outflow tract surgical intervention. Similarly, transcatheter stenting of the ductus arteriosus has supplanted surgical shunt placement in some neonates [17].…”

Section: Techniquesmentioning

confidence: 99%

Excimer laser ablation for valvular angioplasty in pulmonary atresia and intact ventricular septum

2004

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“…• The objective of any treatment plan is to achieve a four-chamber, biventricular heart, with completely separate pulmonary and systemic circulations; this plan has been reviewed time to time by this author [3,[13][14][15]. This aim may be achieved in the absence of 1) right ventricular-dependent coronary circulation, 2) severe right ventricular hypoplasia, and 3) infundibular atresia.…”

Section: Treatment Overviewmentioning

confidence: 99%

Pulmonary atresia with intact ventricular septum

Rao

2002

Curr Treat Options Cardio Med

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The prognosis for patients with pulmonary atresia with intact ventricular septum is poor with and without conventional surgical treatment. Because of this reason, a comprehensive program of medical, transcatheter, and surgical treatment is necessary to improve the long-term outlook of these infants. Algorithms of management plans should be developed based on the presence of right ventricular-dependent coronary circulation as well as size and morphology of the right ventricle. In a tripartite or bipartite right ventricle, transcatheter radiofrequency perforation is preferable. Alternatively, surgical valvotomy may be performed. Augmentation of pulmonary blood flow by prolonged infusion of prostaglandin E(1), stenting the ductus, or a surgical modified Blalock-Taussig shunt may be necessary in some of these patients. In patients with a unipartite or very small right ventricle or a right ventricular-dependent coronary circulation (Tricuspid valve Z score < -2.5), augmentation of pulmonary flow along with atrial septostomy should be undertaken. Follow-up studies to determine the feasibility of biventricular repair should be undertaken and, if feasible, surgical or transcatheter methods may be used to achieve the goals. If not suitable for biventricular repair, one-ventricle (Fontan) or one and one-half ventricular repair should be considered. Comprehensive and well-planned treatment algorithms may help improve survival rate.

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Transcatheter management of neonates with pulmonary atresia and intact ventricular septum

Cited by 38 publications

References 35 publications

Transcatheter Stent Therapy in Children: An Update

Transcatheter Stent Therapy in Children: An Update

Excimer laser ablation for valvular angioplasty in pulmonary atresia and intact ventricular septum

Pulmonary atresia with intact ventricular septum

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