UNLABELLED: Hypoxemia is a significant cause of early and interstage death in patients with single ventricle (SV). Obstruction of Blalock-Taussig shunts (BTS) in patients with SV has traditionally been managed with surgical revision. PURPOSE: We report on the experience at our institution of deploying endovascular stents within BTS as well as obstructed right-ventricle (RV) to pulmonary artery (PA) conduits in patients with modified Norwood (ie Sano modification). METHODS: Medical records were reviewed for the time period between January 1, 2002 and November 30, 2005. All patients with SV who presented for intervention for BTS or RV-PA conduit stenosis were reviewed. Specific endpoints reviewed included pre- and post-intervention arterial oxygen saturation, type of intervention (stent vs. ballon dilation), need for subsequent surgical shunt/conduit revision, and interval to second stage palliation. RESULTS: Fifteen patients with SV underwent intervention for acute cyanosis. Eight patients had BTS, and the other seven patients had RV-PA conduit stenosis. Coronary stents were deployed in 14 of the 15 patients. Four patients also underwent balloon angioplasty of branch PAs. Oxygen saturations improved in all patients, with a mean increase of 13.9% (p = 0.0001). Four patients died before second stage palliation--one due to complications of the catheterization. Of the eleven remaining patients, nine have undergone second stage palliation; interval from intervention to Glenn ranged from 28-205 days (mean 163d). Two patients are awaiting cavo-pulmonary anastamosis. CONCLUSIONS: Endovascular stenting in this high-risk population is effective at improving oxygen saturation as well as obviating need to surgical shunt/conduit revision.
UNLABELLED: Hypoxemia is a significant cause of early and interstage death in patients with single ventricle (SV). Obstruction of Blalock-Taussig shunts (BTS) in patients with SV has traditionally been managed with surgical revision. PURPOSE: We report on the experience at our institution of deploying endovascular stents within BTS as well as obstructed right-ventricle (RV) to pulmonary artery (PA) conduits in patients with modified Norwood (ie Sano modification). METHODS: Medical records were reviewed for the time period between January 1, 2002 and November 30, 2005. All patients with SV who presented for intervention for BTS or RV-PA conduit stenosis were reviewed. Specific endpoints reviewed included pre- and post-intervention arterial oxygen saturation, type of intervention (stent vs. ballon dilation), need for subsequent surgical shunt/conduit revision, and interval to second stage palliation. RESULTS: Fifteen patients with SV underwent intervention for acute cyanosis. Eight patients had BTS, and the other seven patients had RV-PA conduit stenosis. Coronary stents were deployed in 14 of the 15 patients. Four patients also underwent balloon angioplasty of branch PAs. Oxygen saturations improved in all patients, with a mean increase of 13.9% (p = 0.0001). Four patients died before second stage palliation--one due to complications of the catheterization. Of the eleven remaining patients, nine have undergone second stage palliation; interval from intervention to Glenn ranged from 28-205 days (mean 163d). Two patients are awaiting cavo-pulmonary anastamosis. CONCLUSIONS: Endovascular stenting in this high-risk population is effective at improving oxygen saturation as well as obviating need to surgical shunt/conduit revision.
Authors: Jeffrey A Feinstein; D Woodrow Benson; Anne M Dubin; Meryl S Cohen; Dawn M Maxey; William T Mahle; Elfriede Pahl; Juan Villafañe; Ami B Bhatt; Lynn F Peng; Beth Ann Johnson; Alison L Marsden; Curt J Daniels; Nancy A Rudd; Christopher A Caldarone; Kathleen A Mussatto; David L Morales; D Dunbar Ivy; J William Gaynor; James S Tweddell; Barbara J Deal; Anke K Furck; Geoffrey L Rosenthal; Richard G Ohye; Nancy S Ghanayem; John P Cheatham; Wayne Tworetzky; Gerard R Martin Journal: J Am Coll Cardiol Date: 2012-01-03 Impact factor: 24.094