Author + information
- Navaneetha Sasikumar,
- Kyong-Jin Lee,
- Lee Benson and
- Rajiv Chaturvedi
Background: Primary surgical repair of an isolated pulmonary artery can be difficult because of the small vessel and reperfusion pulmonary edema. We evaluated a strategy of primary stenting of the ductal origin of the pulmonary artery followed by later complete repair.
Methods: Retrospective analysis of patients identified from the interventional and surgical databases between 2001 and 2016. Data are presented as median (range), unless otherwise stated.
Results: Twenty-one ducts were stented in 19 patients [age: 13 (2-997) days, weight: 5.98(3.6-13.3) kg]. Ten patients were receiving prostaglandins. Sixteen ducts arose from the innominate artery contralateral to the side of the aortic arch. Ducts required 1 (n=15), 2 (n=4) or 3 (n=2) stents, with 23% deployed by an antegrade approach. Pulmonary edema developed in 53%. ICU and hospital stays were 1 (0-110) days and 4 (1-110) days, respectively. Early in the series, one patient died in the first 24 hours from unrecognized pulmonary overcirculation. Three patients required balloon dilation of the stent prior to surgery. The pulmonary artery distal to the stented duct grew, z-score (mean ± sd): −1.79 ± 1.4 (pre-stent) to −0.71 ± 1.1 (pre-surgery), p=0.02. Surgical unifocalization has been completed in 15 without mortality, 117 (40-210) days after stenting. Post-operatively 5/15 patients required re-interventions.
Conclusions: Ductal stenting secured blood flow to the isolated pulmonary artery without bypass and allowed pulmonary artery growth prior to complete surgical repair. Close monitoring is required for pulmonary edema and high pulmonary blood flow in the first 24 hours after stenting.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovations in Pediatric Catheterization and EP: Mending, Fixing and Predicting
Abstract Category: 11. Congenital Heart Disease: Therapy
Presentation Number: 1144-024
- 2017 American College of Cardiology Foundation