Intraoperative Stenting of Pulmonary Artery Stenosis in Children With Congenital Heart Disease

Autor: Bruno Lefort, Julie Lothion-Boulanger, François Lengellé, Alain Chantepie, Mathilde Meot, Paul Neville, Nathalie Soulé, Jean Marc El Arid
Rok vydání: 2017
Předmět:
Male
Time Factors
medicine.medical_treatment
030204 cardiovascular system & hematology
Intraoperative Period
Postoperative Complications
0302 clinical medicine
Stenosis
Pulmonary Artery
030212 general & internal medicine
Child
Tetralogy of Fallot
Pulmonary artery stenosis
Incidence
Endovascular Procedures
Angiography
Survival Rate
Treatment Outcome
Child
Preschool
Cardiology
Female
Stents
France
Cardiology and Cardiovascular Medicine
Pulmonary atresia
Heart Defects
Congenital
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Adolescent
Pulmonary Artery
03 medical and health sciences
Double outlet right ventricle
Internal medicine
Angioplasty
medicine.artery
medicine
Humans
Cardiac Surgical Procedures
Retrospective Studies
business.industry
Infant
Newborn
Infant
medicine.disease
Surgery
Stenosis
Pulmonary artery
Tomography
X-Ray Computed
business
Follow-Up Studies
Zdroj: The Annals of Thoracic Surgery. 104:190-196
ISSN: 0003-4975
DOI: 10.1016/j.athoracsur.2016.12.012
Popis: Background Branch pulmonary artery (BPA) stenosis is frequently associated with congenital heart disease. Management of BPA stenosis is challenging for surgeons due to a high rate of recurrence. The purpose of this study was to assess the results of intraoperative pulmonary artery stenting associated with or without surgical angioplasty. Methods We included 33 children from our center between January 2008 and July 2014. Patients had pulmonary atresia with ventricular septal defect (13), tetralogy of Fallot (10), troncus arteriosus (4), double outlet right ventricle (2), and single left or right ventricle (4). A total of 44 balloon-expandable stents (mean diameter, 9.5 mm; range, 4 to 16 mm) were deployed in left or right PA under direct visualization, without the use of fluoroscopy, after branch angioplasty for 28 of them (64%). The mean age at surgery was 4.3 ± 4.3 years (range, 6 days to 15 years) and the mean weight was 14.3 ± 11.9 kg (range, 2.8 to 63 kg). Results Postoperative mortality was 9% (3 patients), but only 1 death was related to the stenting procedure. Twenty-five patients underwent angiographic control after a mean follow-up of 22 months after surgery. All stents were well positioned. The mean stented BPA Z-score increased from –2.6 ± 1.8 to –0.4 ± 1.6 ( p 0.0001). Eleven patients experienced intrastent proliferation (44%). Among them, 2 patients required a reoperation for severe intrastent stenosis, whereas the 9 others had mild intrastent neointimal proliferation, which was successfully managed by balloon expansion. Conclusions Intraoperative stenting of BPA is a safe and effective option to treat BPA stenosis and prevent recurrence.
Databáze: OpenAIRE
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