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Ductal stenting to improve pulmonary blood flow in pulmonary atresia with intact ventricular septum and critical pulmonary stenosis after balloon valvuloplasty

Published online by Cambridge University Press:  29 April 2019

Raymond N. Haddad Open the ORCID record for Raymond N. Haddad [Opens in a new window] ,
Najib Hanna ,
Ramy Charbel ,
Linda Daou ,
Ghassan Chehab  and
Zakhia Saliba
Raymond N. Haddad*
Affiliation:
Department of Pediatrics, Hotel-Dieu de France University Medical Center, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
Najib Hanna
Affiliation:
Department of Pediatric Cardiology, Hotel-Dieu de France University Medical Center, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
Ramy Charbel
Affiliation:
Department of Pediatrics, Hotel-Dieu de France University Medical Center, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
Linda Daou
Affiliation:
Department of Pediatric Cardiology, Hotel-Dieu de France University Medical Center, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
Ghassan Chehab
Affiliation:
Department of Pediatric Cardiology, Hotel-Dieu de France University Medical Center, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
Zakhia Saliba
Affiliation:
Department of Pediatric Cardiology, Hotel-Dieu de France University Medical Center, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon
*
Author for correspondence: Raymond Haddad, MD, Department of Pediatrics, Hotel-Dieu de France University Medical Center, Saint Joseph University, Alfred Naccache Boulevard, Achrafieh, Beirut, Lebanon BP: 166830. Tel: +961 70 605 800; Fax: +961 (1) 604 976; E-Mail: raymondhaddad@live.com
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Abstract

Objective:

To assess the feasibility, safety, and efficiency of ductal stenting in pulmonary atresia with intact ventricular septum or critical pulmonary stenosis after balloon pulmonary valvuloplasty.

Background:

Ductal stenting in pulmonary atresia with intact ventricular septum is a re-emerging and promising technique. There is little data available on its outcomes after establishing prograde pulmonary blood flow.

Methods:

We retrospectively reviewed all neonates with pulmonary atresia with intact ventricular septum or critical pulmonary stenosis who underwent ductal stenting after balloon valvuloplasty. Ductal stenting was performed either in the same setting (group A) or a few days later after balloon valvuloplasty (group B). We compared the two groups.

Results:

Eighteen coronary stents were transvenously delivered and successfully deployed in 18 newborns. There was no procedure-related mortality. The median hospital stay post-intervention was 6 days with a mean discharge oxygen saturation of 94%. Group A had a shorter overall hospital stay with a shorter overall time of irradiation but with a longer overall procedural time. On a follow-up of 18 months, no re-intervention for stent failure or overflow was undertaken. The median stent patency based on echocardiography was 12 months.

Conclusion:

Stenting the arterial duct in pulmonary atresia with intact ventricular septum or critical pulmonary stenosis is a feasible, safe, and efficient technique. It avoids surgery or long hospital stay with prostaglandin infusion. The minimal 6 months stent longevity provides a period of time long enough to decide whether the right ventricular diastolic function is normalised or Glenn surgery is still needed.

Keywords

Stentpulmonary atresiainterventricular septumarterial ductal
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 4 , April 2019 , pp. 492 - 498
Copyright
© Cambridge University Press 2019 

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Footnotes

*

Authorship Declaration: All authors listed meet the authorship criteria according to the latest guidelines of the international committee of Medical journal editors, and that all authors are in agreement with the manuscript.

References

Burkholder, H, Balaguru, D. Pulmonary atresia with intact ventricular septum: management options and decision-making. Pediat Therapeut 2012; S5: 007. doi: 10.4172/2161-0665.S5007 CrossRefGoogle Scholar
Raval, A, Thakkar, B, Madan, T, et al. Ductus arteriosus stenting: a promising percutaneous palliation in patients with duct-dependent pulmonary circulation. Rev Port Cardiol 2016; 35: 583–592. doi: 10.1016/j.repc.2016.06.010 CrossRefGoogle Scholar
Santoro, G, Gaio, G, Giugno, L, et al. Ten-years, single-center experience with arterial duct stenting in duct-dependent pulmonary circulation: early results, learning-curve changes, and mid-term outcome. Catheter Cardiovasc Interv 2015; 86: 249–257. doi: 10.1002/ccd.25949 CrossRefGoogle ScholarPubMed
Glatz, A, Petit, C, Goldstein, BH, et al. Comparison between patent ductus arteriosus stent and modified Blalock-Taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow: insights from the congenital catheterization research collaborative. Circulation 2018; 137: 589–601. doi: 10.1161/CIRCULATIONAHA.117.029987 CrossRefGoogle ScholarPubMed
Bentham, JR, Zava, NK, Harrison, WJ, et al. Duct stenting versus modified Blalock-Taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter national study. Circulation 2018; 137: 581–588. doi: 10.1161/CIRCULATIONAHA.117.028972. Epub 2017 Oct 30.CrossRefGoogle Scholar
Schranz, D, Michel-Behnke, I, Heyer, R, et al. Stent implantation of the arterial duct in newborns with a truly duct-dependent pulmonary circulation: a single-center experience with emphasis on aspects of the interventional technique. J Interv Cardiol 2010; 23: 581–588. doi: 10.1111/j.1540-8183.2010.00576.x CrossRefGoogle ScholarPubMed
Mallula, K, Vaughn, G, El-Said, H, Lamberti, JJ, Moore, JW. Comparison of ductal stenting versus surgical shunts for palliation of patients with pulmonary atresia and intact ventricular septum. Catheter Cardiovasc Interv 2015; 85: 1196–1202. doi: 10.1002/ccd.25870 CrossRefGoogle ScholarPubMed
Mortera, C, Rissech, M, Bartrons, J, Carretero, J, Prada, F. Ductus arteriosus patency with stenting in critical pulmonary stenosis and pulmonary atresia with intact interventricular septum. Rev Esp Cardiol 2005; 58: 592–595.CrossRefGoogle ScholarPubMed
Alwi, M, Choo, KK, Radzi, NA, Samion, H, Pau, KK, Hew, CC. Concomitant stenting of the patent ductus arteriosus and radiofrequency valvotomy in pulmonary atresia with intact ventricular septum and intermediate right ventricle: early in-hospital and medium-term outcomes. J Thorac Cardiovasc Surg 2011; 141: 1355–1361. doi: 10.1016/j.jtcvs.2010.08.085 CrossRefGoogle ScholarPubMed
Alwi, M, Geetha, K, Bilkis, AA, et al. Pulmonary atresia with intact ventricular septum percutaneous radiofrequency-assisted valvotomy and balloon dilation versus surgical valvotomy and Blalock–Taussig shunt. J Am Coll Cardiol 2000; 35: 468–476.CrossRefGoogle ScholarPubMed
Weber, HS. Initial and late results after catheter intervention for neonatal critical pulmonary valve stenosis and atresia with intact ventricular septum: a technique in continual evolution. Catheter Cardiovasc Interv 2002; 56: 394–399. CrossRefGoogle ScholarPubMed
Chubb, H, Pesonen, E, Sivasubramanian, S, et al. Long-term outcome following catheter valvotomy for pulmonary atresia with intact ventricular septum. J Am Coll Cardiol 2012; 59: 1468–1476. doi: 10.1016/j.jacc.2012.01.022 CrossRefGoogle ScholarPubMed
Xu, WZ, Xia, CS, Zhang, ZW, Li, JH, Zhou, YB, Yu, JG. Efficacy of arterial duct stenting in neonatal pulmonary atresia with intact ventricular septum. Zhonghua Xin Xue Guan Bing Za Zhi 2011; 39: 621–624.Google ScholarPubMed
Alwi, M, Mood, MC. Stenting of lesions in patent ductus arteriosus with duct-dependent pulmonary blood flow: focus on case selection, techniques and outcome. Interv Cardiol Clin 2013; 2: 93–113. doi: 10.1016/j.iccl.2012.09.011 Google ScholarPubMed
Alwi, M. Stenting the ductus arteriosus: case selection, technique and possible complications. Ann Pediatr Cardiol 2008; 1: 38–45. doi: 10.4103/0974-2069.41054 CrossRefGoogle Scholar
Alwi, M. Stenting the patent ductus arteriosus in duct-dependent pulmonary circulation: techniques, complications and follow-up issues. Future Cardiol 2012; 8: 237–250. doi: 10.2217/fca.12.4 CrossRefGoogle ScholarPubMed
Udink Ten Cate, FE, Sreeram, N, Hamza, H, Agha, H, Rosenthal, E, Qureshi, SA. Stenting the arterial duct in neonates and infants with congenital heart disease and duct-dependent pulmonary blood flow: a multicenter experience of an evolving therapy over 18 years. Catheter Cardiovasc Intervent Off J Soc Cardiac Angiogr Intervent 2013; 82: E233–E243. doi: 10.1002/ccd.24878 CrossRefGoogle ScholarPubMed
Lucas, V. Critical pulmonary valve stenosis and pulmonary atresia/intact ventricular septum: to lump or split? Examining procedural success and risk for reintervention. Catheter Cardiovasc Intervent 2012; 79: 665. doi: 10.1002/ccd.24341 CrossRefGoogle ScholarPubMed
Bakhru, S, Marathe, S, Saxena, M, et al. Transcatheter pulmonary valve perforation using chronic total occlusion wire in pulmonary atresia with intact ventricular septum. Ann Pediatr Cardiol 2017; 10: 5–10. doi: 10.4103/0974-2069.197065 Google ScholarPubMed
Alwi, M, Budi, RR, Mood, MC, Leong, MC, Samion, H. Pulmonary atresia with intact septum: the use of Conquest Pro coronary guidewire for perforation of atretic valve and subsequent interventions. Cardiol Young 2013; 23: 197–202. doi: 10.1017/S1047951112000595 CrossRefGoogle ScholarPubMed
McMullan, DM, Permut, LC, Jones, TK, Johnston, TA, Rubio, AE. Modified Blalock–Taussig shunt versus ductal stenting for palliation of cardiac lesions with inadequate pulmonary blood flow. J Thorac Cardiovasc Surg 2014; 47: 397–401. doi: 10.1016/j.jtcvs.2013.07.052 CrossRefGoogle Scholar
Santoro, G, Gaio, G, Palladino, MT, et al. Arterial duct stenting: do we still need surgical shunt in congenital heart malformations with duct-dependent pulmonary circulation? J Cardiovasc Med (Hagerstown) 2010; 11:852–857. doi: 10.2459/JCM.0b013e32833a070d CrossRefGoogle ScholarPubMed
Matter, M, Almarsafawey, H, Hafez, M, Attia, G, Abuelkheir, MM. Patent ductus arteriosus stenting in complex congenital heart disease: early and midterm results for a single-center experience at children hospital, Mansoura, Egypt. Pediatr Cardiol 2013; 34:1100–1106. doi: 10.1007/s00246-012-0608-x CrossRefGoogle Scholar