Stenting of the inter-atrial septum in infants and small children: Indications, techniques and outcomes (original) (raw)
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Atrial stenting: case based elaboration of indications
2020
In certain forms of congenital and acquired heart defects, wide interatrial communication is important to maintain hemodynamics. In comparison to balloon septostomy or blade septostomy, atrial septal stenting provides a controlled, predictable, and long-lasting atrial communication particularly in children and older age groups. Even though there are theoretical high risks of embolization, atrial stenting proves to be an effective palliative method. We describe 3 cases that underwent atrial stenting for different hemodynamic reasons. All three cases had different age groups. Two of them were moribund sick. Cases were performed under general anaesthesia with the help of transthoracic and transesophageal echo. Since it is uncommon procedure, we hope that this paper will the help in understanding clinical applications.
Catheterization and Cardiovascular Interventions, 2008
Background: Stents implantation in infants has been shown to be feasible, however, there are no published reports examining long-term outcomes. Concerns exist regarding creation of fixed obstructions secondary to the stent if expansion to larger diameters over time is not possible. Methods: A retrospective analysis of the earliest consecutive series of infants who underwent stent placement at our institution between October 1995 and December 1999. Results: Implantation of 33 stents were attempted in 27 infants, median age = 10 (25–24) months, wt = 8.1 (3.4–14.5) kg. Stents used were as follows: 16 large, 13 medium, and 4 coronary. Acute implant success was 94%. There were three nonprocedure-related deaths within 30 days of implantation, 1 patient was lost to follow-up and 1 had acute stent thrombosis. The remaining 22 patients (26 stents) form the long-term follow-up study group. Nineteen stents underwent 33 redilations. Following latest redilation, 67.0 (37–113) months postimplantation, minimal luminal diameter increased from 7.0 ± 1.8 mm immediately following implantation to 8.7 ± 2.3 mm (P < 0.001). Seven stents were electively removed/ligated during a planned surgery. All 18 remaining in situ stents are patent without significant obstruction 102 (84–116) months following implantation. There was one late death 51 months after stent implantation. The remaining 21 patients are alive and well. Conclusions: Stent implantation in infants is safe and effective. Serial redilation is possible to keep pace with somatic growth; however, efforts should be made to implant stents with adult diameter potential in children who will not require further cardiac surgery. Implantation of small- and medium-sized stents can provide effective palliation and should be considered in carefully selected infants who will ultimately require future surgery. © 2008 Wiley-Liss, Inc.
Congenital Heart Disease, 2017
Background: Right ventricular outflow tract (RVOT) stents have been used as palliation in patients with severe tetralogy of Fallot (TOF). Radiofrequency perforation of the RVOT has also been described in patients with pulmonary atresia (PA)/ventricular septal defect (VSD). However, RVOT stenting in conjunction with radiofrequency perforation as a means for establishing reliable pulmonary blood flow in patients with PA/VSD has not previously been reported. Objectives: Our aim is to report our experience with using perforation of plate-like pulmonary valve atresia combined with stenting of RVOT as an alternative and equally efficacious intervention for infants with PA/VSD, as compared to a surgical pulmonary artery shunt (SPS). Methods: A retrospective review of patients with PA/VSD at our institution from Jan 2006 to October 2015 was performed. Results: Twenty-seven patients received palliation for PA/VSD. Five (median 2.5 kg, 2.1-4.1 kg) underwent RVOT stenting and 22 (3.5 kg, 2.1-4.6 kg) underwent surgical SPS. Of the patients who received an RVOT stent, 3 underwent guidewire perforation and balloon dilation of the plate-like pulmonary valve, and 2 underwent radiofrequency perforation of the pulmonary plate, followed by balloon dilation. Postprocedure saturations averaged 93% in the stent group and 89% in the shunt group. One of the patients who underwent RVOT stenting required additional stenting of the PDA for isolation of the LPA, but none required re-intervention. Four patients in the SPS cohort required re-intervention (18%). Two required stenting of the shunt, and 2 required surgical revision of the shunt. There was one death in the stent group, however this was secondary to withdrawal of support given an underlying genetic diagnosis (trisomy 13). There was one fatality in the SPS cohort prior to hospital discharge. Conclusions: Perforation followed by RVOT stenting may be a safe and effective alternative to surgical SPS in infants with PA/VSD.
Catheterization and Cardiovascular Interventions, 2007
Objectives: To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques. Background: For some complex congenital heart defects, an unrestrictive atrial septal defect (ASD) is essential to achieve an adequate cardiac output and/or systemic saturation. In some scenarios, the use of conventional septostomy techniques may be technically difficult, hazardous, and/or ineffective. Methods: Use of transhepatic approach, cutting balloons, and radiofrequency perforation with stenting of the atrial septum. Results: The size of the ASD and the oxygen saturation increased in all patients with no major complications. In those with TGA, the ASDs were considered to be of good size at the arterial switch operation. Two of the 3 patients with hybrid palliation for HLHS have developed some degree of obstruction within the interatrial stent over 2-3 months. At surgery, the stents were found to be secured within the septum with one showing significant fibrous ingrowth after uneventful removal. The other had some nonobstructive ingrowth. Conclusions: Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the shortto-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction. ' 2007 Wiley-Liss, Inc.
The Egyptian Heart Journal, 2017
Introduction: Surgery in very young children with critical obstructive congenital heart disease has a high morbidity and mortality. The aim of this study was to determine whether the use of small stents is feasible and if it could delay surgery. Materials and methods: Nineteen children were included in a retrospective review spanning 7 years. Patients were included in circumstances where surgery needed to be delayed and the use of a small stent could alleviate the underlying obstruction. Results: All attempts at stenting were successful (100%). Indications were diverse and included: aortic obstruction (n=9), right ventricular outfl ow tract obstruction (n=3), systemic-to-pulmonary artery shunt occlusion (n=5), infradiaphragmatic pulmonary vein obstruction (n=1) and salvage of a discontinuous left pulmonary artery (n=1). Reasons patients were not fi t for surgical intervention included: low weight (n=4), poor general clinical condition (n=12), surgical technical diffi culty (n=2) and...