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

Abstract

Stenting of systemic to pulmonary artery shunt is a safe and effective procedure and avoids surgical re-intervention. It can be performed both as a rescue procedure in patients with acute shunt occlusion and as an elective procedure to palliate patients not yet suitable for subsequent corrective or staged repair.

Stenting of the right ventricular outflow tract as primary palliation for Fallot-type lesions

“…Modern coronary interventional kit is suitable for catheter interventions in even premature neonates. As a consequence of this, and with the experience of stent implantation into the patent arterial duct or stenosed BT shunts [16,17], there has been a re-consideration of stenting the right ventricular outflow tract in patients with tetralogy of Fallot after initial attempts by Hausdorff and Gibbs had been disappointing [7]. This paper summarizes the institutional experience and learning curve with stenting the RVOT in symptomatic patients with severe Fallot physiology.…”

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

“…Over recent decades, neonates and infants have increasingly been undergoing catheterizations after surgery for congenital heart defects for therapeutic purposes in elective and urgent clinical settings. 1,2,5,7,9 This non-controlled proof-of-concept analysis demonstrates that surgically placed radiopaque markers that reveal the proximal entry of a systemic-to-pulmonary artery shunt or the arterial duct proved to be feasible and a beneficial method to facilitate postoperative percutaneous procedures in 25 cardiac catheterizations at our center. The strategy we describe is easy to implement surgically and would be similarly helpful for interventionalists at other pediatric-cardiology centers.…”

“…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.…”

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

“…For patients that develop graft obstruction, the risk of surgery versus catheter intervention must be weighed. Literature to date has reported the risks of shunt revision and the feasibility of percutaneous graft stenting and overdilation . This single‐center cohort study now contributes a large experience of stent interventions and overdilation practice for small Gore‐Tex ® grafts over a range of indications: addressing safety, technical results, and long‐term clinical impact.…”

“…This was rapidly replaced by stent implantation (due to safety concerns), described in case reports and small series . Of late, graft stenting has emerged as an important interstage intervention , particularly in centers utilizing the Sano modification to classical Norwood . Using stents to overdilate Gore‐Tex ® grafts beyond their (factory designated) nominal diameters was initially established on the bench and feasibility in vivo has since been described in a total of 15 patients in two series and one case report .…”