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Use of balloon expandable stents in the palliative relief of obstructed right ventricular conduits

Published online by Cambridge University Press:  19 August 2008

Alison M. Hayes ,
David G. Nykanen ,
Brian W. McCrindle ,
Jeffrey F. Smallhorn ,
Robert M. Freedom  and
Lee N. Benson
Alison M. Hayes
Affiliation:
Department of Pediatrics, Division of Cardiology, and the Variety Club Cardiac Catheterization, University of Toronto School of Medicine, The Hospital for Sick Children, Toronto, Canada
David G. Nykanen
Affiliation:
Department of Pediatrics, Division of Cardiology, and the Variety Club Cardiac Catheterization, University of Toronto School of Medicine, The Hospital for Sick Children, Toronto, Canada
Brian W. McCrindle
Affiliation:
Department of Pediatrics, Division of Cardiology, and the Variety Club Cardiac Catheterization, University of Toronto School of Medicine, The Hospital for Sick Children, Toronto, Canada
Jeffrey F. Smallhorn
Affiliation:
Department of Pediatrics, Division of Cardiology, and the Variety Club Cardiac Catheterization, University of Toronto School of Medicine, The Hospital for Sick Children, Toronto, Canada
Robert M. Freedom
Affiliation:
Department of Pediatrics, Division of Cardiology, and the Variety Club Cardiac Catheterization, University of Toronto School of Medicine, The Hospital for Sick Children, Toronto, Canada
Lee N. Benson*
Affiliation:
Department of Pediatrics, Division of Cardiology, and the Variety Club Cardiac Catheterization, University of Toronto School of Medicine, The Hospital for Sick Children, Toronto, Canada
*
Dr LN Benson, Division of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. Tel 416 813 6141, Fax: 416 813 7547
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Abstract

Objectives

The purpose of this study was to determine the efficacy of balloon expandable stents in the relief of obstructed conduits in the right heart, and to review both the immediate success and longevity of this palliation.

Methods and results

Endovascular stents where placed in 17 children, median age 4.7 yrs (range 0.46–16.2 yrs), at a median of 1.6 yrs (range 0.33–6.7 yrs) after placement of conduits at surgery. A second stent was required in two children, either because of migration of the initial stent or residual proximal stenosis. Mean right ventricular to systemic pressure ratios were reduced from 0.77 ±0.24 to 0.50±0.13, and the minimum area of the pulmonary outflow tract increased from 24±12% to 69±26% of that expected for body surface area. Further surgery was needed in 8 patients following placement of the stent, in 5 within 10 months of implantation, due to inadequate relief of obstruction. Nonetheless, 3 of these 8 children achieved satisfac­tory palliation 18, 21 and 24 months prior to requiring insertion of a new conduit. Actuarial freedom from reoperation was 44% at 24 months. The remaining 9 children continue to benefit from the relief in obstruction provided by the stent at a mean interval from implantation of 24±8 months. In this group, the mean Doppler gradient across the right ventricular outflow tract was 35 ±13 mmHg (n=6).

Conclusions

These early data indicate that endovascular stents are useful in the palliation of obstructed right ventricular conduits. In the short-term, the relief of obstruction achieved is well maintained, and has either delayed or obviated the need for insertion of new conduits.

Keywords

Cardiac catheterizationstentsballoon dilatationventricular outflow obstruction
Type
Brief-Reports
Information
Cardiology in the Young , Volume 7 , Issue 4 , October 1997 , pp. 423 - 433
Copyright
Copyright © Cambridge University Press 1997

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References

1.McGoon, DC, Danielson, GK, Puga, FJ, Ritter, DG, Mair, DD, Ilstrup, DM. Late results after extracardiac repair for congenital cardiac defects. Am J Cardiol 1982; 49(7): 1741–1749.CrossRefGoogle ScholarPubMed
2.Sano, S, Karl, TR, Mee, RB. Extracardiac valved conduits in the pulmonary circuit. Ann Thorac Surg 1991; 52: 285–290.CrossRefGoogle ScholarPubMed
3.Razzouk, AJ, Williams, WG, Cleveland, DC, et al. Surgical connections from ventricle to pulmonary artery. Comparison of four types of valved implants. Circulation 1992; 86(5 suppl II):II-150–II-153.Google ScholarPubMed
4.Zeevi, B, Keane, JF, Perry, SB, Lock, JE. Balloon dilatation of postoperative right ventricular outflow obstructions. J Am Coll Cardiol 1989; 14: 397–400.CrossRefGoogle ScholarPubMed
5.Mullins, CE, Latson, LA, Neches, WH, Colvin, EV, Kan, J. Balloon dilatation of miscellanous lesions: Results of valvuloplasty and angioplasty of congenital anomalies registry. Am J Cardiol 1990; 65: 802–803.CrossRefGoogle Scholar
6.Ensing, GJ, Hagler, DJ, Seward, JB, Julsrud, PR, Mair, DD. Caveats of balloon dilation of conduits and conduit valves. J Am Coll Cardiol 1989; 14: 397–400.CrossRefGoogle ScholarPubMed
7.Almagor, Y, Prevosti, LG, Bartorelli, AL, et al. Balloon expandable stent implantation in stenotic right heart valved conduits. J Am Coll Cardiol 1990; 16: 1310–1314.CrossRefGoogle ScholarPubMed
8.Hosking, McK, Benson, LB, Nakanishi, T, Burrows, PE, Williams, WG, Freedom, RM. Intravascular stent prosthesis for right ventricular outflow tract obstruction. J Am Coll Cardiol 1992; 20: 373–380.CrossRefGoogle Scholar
9.Stark, J, de, Laval M. Surgery for congenital heart disease. Grune and Stratton, 1983, p460Google Scholar
10.Bove, EL, Byrum, CJ, Deaver, Thomas F, et al. The influence of pulmonary insufficiency on ventricular function following repair of tetralogy of Fallot. J Thor Cardiovasc Surg 1983; 85: 691–696.CrossRefGoogle ScholarPubMed
11.Ilbawi, MN, Idriss, FS, DeLeon, SY, et al. Factors that exaggerate the deleterious effects of pulmonary insufficiency on the right ventricle after tetralogy repair. J Thorac Cardiovasc Surg 1987; 93: 36–44.CrossRefGoogle ScholarPubMed
12.Mullins, CE, O‘Laughlin, MP, Vick, GW III et al. Implantation of balloon-expandable intravascular grafts by catheterization in pulmonary arteries and systemic veins. Circulation 1988; 77: 188–199.CrossRefGoogle ScholarPubMed
13.Benson, LN, Hamilton, F, Dasmahapatra, H, Rabinovitch, M, Coles, JC, Freedom, RM. Percutaneous implantation of a balloon-expandable stent endoprosthesis: an experimental study. J Am Coll Cardiol 1991; 18: 1303–1308.CrossRefGoogle ScholarPubMed
14.O‘Laughlin, MP, Perry, SB, Lock, JE, Mullins, CE. Use of endovascular stents in congenital heart disease. Circulation 1991; 83: 1923–1939.CrossRefGoogle ScholarPubMed
15.Fogelman, R, Nykanen, D, Smallhorn, JF, McCrindle, BW, Freedom, RM, Benson, LN. Endovascular stents in the pulmonary circulation. Clinical impact on management and medium term followup. Circulation 1995; 4: 881–885.CrossRefGoogle Scholar
16.O'Laughlin, MP, Slack, Mc, Grifka, RG, Perry, SB, Lock, JE, Mullins, CE. Implantation and intermediate-term follow-up of stents in congenital heart disease. Circulation 1993; 88: 605–614.CrossRefGoogle ScholarPubMed
17.Powell, AJ, Lock, JE, Keane, JF, Perry, SB. Prolongation of RV-PA conduir lifespan by percutaneous stent implantation. Circulation 1995; 92: 3282–328.CrossRefGoogle Scholar