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Experience of stent implantation for recurrent aortic arch obstruction following Norwood or Damus–Kaye–Stansel operation over the last decade

Published online by Cambridge University Press:  24 July 2019

Brian McCrossan ,
Lars Nolke ,
Damien Kenny ,
Paul Oslizlok ,
Gloria Crispino ,
Kevin P. Walsh  and
Colin J. McMahon
Brian McCrossan
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
Lars Nolke
Affiliation:
Department of Paediatric Cardiothoracic Surgery, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
Damien Kenny
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
Paul Oslizlok
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
Gloria Crispino
Affiliation:
National Clinical Research Centre, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland StatisticaMedica Ltd.Dublin 18, Ireland
Kevin P. Walsh
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
Colin J. McMahon*
Affiliation:
Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland
*
Author for correspondence: Dr Colin J. McMahon, FAAP FACC FRCPI, Department of Paediatric Cardiology, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland. Tel: 01 4096160; E-mail: [email protected]
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Abstract

Background:

Recurrent aortic arch obstruction following the Norwood procedure is recognised as an important complication. Balloon arch angioplasty is associated with a high recoarctation rate.

Methods:

We sought to evaluate the prevalence and outcome of stent implantation for recoarctation in children following Norwood or Damus–Kaye–Stansel procedure over the past decade at a single national cardiology centre.

Results:

Of 114 children who underwent Norwood procedure or Damus–Kaye–Stansel procedure between January 2003 and June 2013, 80 patients survived. Of these 15 children underwent stent implantation for recoarctation. Six of these patients had previous balloon angioplasty. The median age at stent implantation was 4.4 months (range 2–82 months). The median peak aortic arch gradient at catheterisation decreased from 26mmHg (range 10–70mmHg) to 2mmHg (range 0–20mmHg). The median luminal diameter increased from 4.7 mm (range 3.2–7.9 mm) to 8.6 mm (range 6.2–10.9 mm). The median coarctation index increased by 0.49 (range = 0.24–0.64). A Valeo stent was employed in 11 children, a Palmaz Genesis stent in 2 patients, a MultiLink stent in 1 child, and a Jomed covered stent in 1 child. Two factors were associated with the need for stent placement: previous arch angioplasty (p valve < 0.001, χ-square 11.5) and borderline left ventricle (p = 0.04, χ-square = 4.1). Stent migration occurred in one child. There were two deaths related to poor right ventricular systolic function and severe tricuspid regurgitation. Six patients underwent redilation of the stent with no complications.

Conclusions:

The prevalence of recurrent aortic arch obstruction following Norwood/Damus–Kaye–Stansel procedure was 18%. Stent implantation is safe and reliably eliminates the aortic obstruction. Redilation can be successfully achieved to accommodate somatic growth or development of stent recoarctation.

Keywords

Coarctationstenthypoplastic left heart syndromeNorwood operationDamus–Kaye–Stansel procedure
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 9 , September 2019 , pp. 1137 - 1142
Copyright
© Cambridge University Press 2019 

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