Eric Rosenthal1, Shakeel A Qureshi1, Matthew Jones1, Gianfranco Butera1,2, Kothandam Sivakumar3, Younes Boudjemline4, Ziyad M Hijazi4, Salim Almaskary5, Reid D Ponder6, Morris M Salem6, Kevin Walsh7, Damien Kenny7, Sebastien Hascoet8, Darren P Berman9, John Thomson10, Joseph J Vettukattil11, Evan M Zahn12. 1. Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK. 2. Department of Paediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, Rome, Italy. 3. Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India. 4. Cardiology, Sidra Heart Center, Doha, Qatar. 5. Paediatric Cardiology, National Heart Centre, Muscat, Oman. 6. Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA. 7. Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland. 8. Department of Congenital Heart Diseases, Centre de Reference Cardiopathies Congenitales Complexes M3C, Hospital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Universite Paris-Saclay, Paris, France. 9. Cardiac Catheterization Laboratory, Nationwide Children's Hospital, Columbus, Ohio, USA. 10. Department of Congenital Cardiology, Leeds General Infirmary, Leeds, UK. 11. Congenital Cardiology, Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA. 12. The Department of Pediatrics, The Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA.
Abstract
BACKGROUND: Covered stent correction of sinus venosus ASDs (SVASD) is a relatively new technique. Challenges include anchoring a sufficiently long stent in a nonstenotic superior vena cava (SVC) and expanding the stent at the wider SVC-RA junction without obstructing the anomalous right upper pulmonary vein (RUPV). The 10-zig covered Cheatham-platinum (CCP) stent has the advantage of being available in lengths of 5-11 cm and dilatable to 34 mm in diameter. METHODS: An international registry reviewed the outcomes of 10-zig CCP stents in 75 patients aged 11.4-75.9 years (median 45.4) from March 2016. Additional stents were used to anchor the stent in the SVC or close residual shunts in 33/75. An additional stent was placed in 4/5 (80%) with 5/5.5 cm CCPs, 18/29 (62%) with 6 cm CCPs, 5/18 (28%) with 7 cm CCPs, 5/22 (23%) with 7.5/8 cm CCPs and 0/1 with an 11 cm CCP. A "protective" balloon catheter was inflated in the RUPV in 17. RESULTS: Early stent embolization in two patients required surgical removal and defect repair and tamponade was drained in one patient. The CT at 3 months showed occlusion of the RUPV in one patient. Follow up is from 2 months to 5.1 years (median 1.8 years). QP:QS has reduced from 2.5 ± 0.5 to 1.2 ± 0.36 (p < .001) and RVEDVi from 149.1 ± 35.4 to 95.6 ± 21.43 ml/m2 (p < .001). CONCLUSIONS: Ten-zig CCPs of 7-8 cm appear to provide reliable SVASD closure with a low requirement for additional stents. Careful selection of patients and meticulous attention to detail is required to avoid complications.
BACKGROUND: Covered stent correction of sinus venosus ASDs (SVASD) is a relatively new technique. Challenges include anchoring a sufficiently long stent in a nonstenotic superior vena cava (SVC) and expanding the stent at the wider SVC-RA junction without obstructing the anomalous right upper pulmonary vein (RUPV). The 10-zig covered Cheatham-platinum (CCP) stent has the advantage of being available in lengths of 5-11 cm and dilatable to 34 mm in diameter. METHODS: An international registry reviewed the outcomes of 10-zig CCP stents in 75 patients aged 11.4-75.9 years (median 45.4) from March 2016. Additional stents were used to anchor the stent in the SVC or close residual shunts in 33/75. An additional stent was placed in 4/5 (80%) with 5/5.5 cm CCPs, 18/29 (62%) with 6 cm CCPs, 5/18 (28%) with 7 cm CCPs, 5/22 (23%) with 7.5/8 cm CCPs and 0/1 with an 11 cm CCP. A "protective" balloon catheter was inflated in the RUPV in 17. RESULTS: Early stent embolization in two patients required surgical removal and defect repair and tamponade was drained in one patient. The CT at 3 months showed occlusion of the RUPV in one patient. Follow up is from 2 months to 5.1 years (median 1.8 years). QP:QS has reduced from 2.5 ± 0.5 to 1.2 ± 0.36 (p < .001) and RVEDVi from 149.1 ± 35.4 to 95.6 ± 21.43 ml/m2 (p < .001). CONCLUSIONS: Ten-zig CCPs of 7-8 cm appear to provide reliable SVASD closure with a low requirement for additional stents. Careful selection of patients and meticulous attention to detail is required to avoid complications.
Authors: Abhay A Divekar; Yousef M Arar; Stephen Clark; Animesh Tandon; Thomas M Zellers; Surendranath R Veeram Reddy Journal: Children (Basel) Date: 2022-04-02