Bilateral ductal stenting in a neonate with right isolated pulmonary artery of ductal origin and differential pulmonary vascular resistances

We report our experience with stenting a right ductus arteriosus in a neonate with ductal origin of the right pulmonary artery (PA), who subsequently developed severe pulmonary hypertension in the left PA requiring decompression of the right ventricle with stenting of the left ductus. © 2015 Wiley Periodicals, Inc.     

Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting

Stent angioplasty of patent ductus arteriosus has been shown to be a viable alternative to operative shunt placement in cyanotic neonates. With broader implementation of this strategy, novel complications are bound to arise. We present a series of cases evaluated for ductal stent angioplasty in which a dilated and torturous ductus arteriosus compressed the left mainstem bronchus. After reviewing our recent experience with ductal stenting and isolated Blalock‐Taussig shunts, our best estimate of the incidence of bronchial compression by the dilated ductus is 4.6% (3/64, 95% confidence interval 1.0–12.9%). Awareness of the airway and other nonvascular contents of the thorax is an important consideration prior to ductal stenting.     

Apical muscular ventricular septal defect closure via hybrid approach using a right ventricular stay suture

Transcatheter closure of large apical muscular ventricular septal defects (VSDs) can be performed via transfemoral or hybrid approach. A very large apical muscular VSD was closed via a hybrid approach. A strategy for deployment of a right ventricular stay suture was utilized to minimize the risk of device embolization without the use of bypass and without externalization of a portion of the device.     

Bilateral branch pulmonary artery Pulsta valve implantation for treatment of large right ventricular outflow tract in a high-risk patient

Percutaneous pulmonary valve implantation (PPVI) has been implemented as a novel alternative strategy to surgical pulmonary valve replacement. However, PPVI has an inevitable limitation: the large right ventricular outflow tract (RVOT) lesions exhibit variable geometry and significant pulmonary regurgitation (PR). To overcome this limitation, bilateral branch pulmonary artery (PA) valve implantations using Melody or Sapien valves have been attempted and have shown a reduction in right ventricular volume with clinical benefits in the intermediate term. Nevertheless, these trials also have constraints of large branch PA size. Recently, a feasibility study using the Pulsta valve (Tae Woong Medical Co, Gyeonggi-do, South Korea) for native RVOTs was reported; the diameter of the Pulsta valve ranges from 18 to 32 mm. Herein, we present a successful percutaneous bilateral branch PA valve implantation using two 32 mm Pulsta valves in a 59-year-old man who showed right heart failure with severe pulmonary regurgitation despite several open heart surgeries for tetralogy of Fallot. The main PA was measured to be 49 mm, and both the right and left PAs were measured to be 30 mm.     

Transcatheter redirection of hepatic venous blood to treat unilateral pulmonary arteriovenous malformations in a Fontan circulation by short‐term total exclusion of the unaffected lung

Clinically significant unilateral pulmonary arteriovenous malformations (PAVM) can develop in patients with a Fontan circulation when there is unbalanced distribution of hepatic venous (HV) blood flow to the lungs. There are reported surgical and transcatheter techniques to treat PAVMs by rerouting HV return, with promising short‐term results. We report a case of a novel, technically simple transcatheter approach to redirect HV blood flow in an adult Fontan patient with polysplenia syndrome and severe unilateral PAVMs. Our patient had a two‐stage procedure, the first to redirect all HV blood flow to the affected lung with a single covered stent, and a second to confirm resolution of PAVMs and to reintroduce HV effluent to the unaffected lung. At 10‐month follow‐up, her oxygen saturations had increased from 75% to 93% with a marked improvement in her functional status.     

Percutaneous pulmonary valve implantation in the native right ventricular outflow tract

Percutaneous pulmonary valve implantation into dysfunctional right ventricular (RV) to pulmonary artery conduits is being increasingly performed in many European and North American centers with satisfactory results and low‐complication rates. We report the first application of this elaborate technique in the native RV outflow tract of a young patient who developed severe supravalvular pulmonary stenosis following an arterial switch operation for transposition of the great arteries. The procedure may be used as an alternative to surgical repair for the treatment of selected patients with supravalvular pulmonary stenosis complicating congenital heart surgery. © 2011 Wiley Periodicals, Inc.     

Stenting the vertical neonatal ductus arteriosus via the percutaneous axillary approach

Background/Objective: Stenting the ductus arteriosus (DAS) has become an alternative to surgical systemic to pulmonary artery shunts in neonates with ductal‐ dependent pulmonary blood flow (PBF). Femoral approach for a vertical ductus can be difficult secondary to the acute angle and tortuous course, thus alternative ac‐ cess sites have been explored. Carotid access complications have been reported in 5%‐10%. The extensive use of an axillary arterial approach in the United States has not been reported. The aim of this study is to describe our experience with DAS using the axillary approach.
Methods: We reviewed all patients with DAS with an axillary approach in neonates with ductal‐dependent PBF (May 2017‐May 2018) in our institution. Procedural re‐ ports, angiograms, and clinical records of all consecutive patients were reviewed. Procedural technique, procedural outcomes, adverse events, and post‐hospital courses are reported.
Results: Seven consecutive patients who received DAS utilizing axillary approach. All patients had ductal‐dependent PBF through a vertical, tortuous ductus. Five had pulmonary atresia or near atresia, one had compromised PBF due to dynamic subval‐ var obstruction, and one had Tetralogy of Fallot with isolated left pulmonary artery. Axillary access with 3.3 or 4 French sheath was obtained using ultrasound guidance. Bare metal coronary stents were deployed successfully in all. Intra‐procedure, one developed in stent thrombus requiring re‐stenting. There were no procedural mor‐ talities or major adverse events from axillary access. There is a steep learning curve. Hemostasis was achieved with manual compression. Two patients had reintervention at 6‐8 weeks. All patients underwent successful planned surgeries.
Conclusion: This series suggests DAS in neonates utilizing an axillary approach is a feasible and effective alternative for establishing PBF. Axillary arterial approach may be preferred as there is no risk to neurological sequelae and very low risk of limb complications. Larger series are needed to validate this approach.     

Left ventricular segmental dysfunction following percutaneous transcatheter closure of a membranous ventricular septal defect.

Percutaneous device closure of membranous ventricular septal defects is an attractive alternative for surgical treatment. A patient with left ventricular segmental dysfunction with infarct like ECG pattern following transcatheter membranous VSD closure is presented. Possible pathophysiological mechanisms of this phenomenon are discussed.     

Percutaneous closure of perimembranous ventricular septal defect associated with a ventricular septal aneurysm using the Amplatzer ductal occluder.

Amplatzer ductal occluders were used for percutaneous closure of perimembranous ventricular septal defects with associated ventricular septal aneurysm in three patients. The device was well positioned and the ventricular left-to-right shunt was significantly decreased in all three patients. The procedure was tolerated well without complications in each case.     

新型无支架生物瓣带瓣管道用于右室流出道重建

目的:验证新型无支架生物瓣带瓣管道应用于右室流出道重建术中的有效性和安全性。方法:2007年11月～2008年5月,全组7例复杂先天性心脏病患者使用了新型无支架牛心包带瓣管道重建右室流出道,其中Rastelli手术6例、Nikaidoh手术1例。通过术后不同时期超声检查结果,记录肺动脉压、血流速度、新建肺动脉瓣跨瓣压差及开口面积和返流情况,了解肺动脉管道直径、有无瘤样扩张以及远端吻合口压差等,对移植的无支架生物瓣带瓣管道的临床性能进行评价。结果:所有患者住院期间均无吻合口渗血、心内膜炎、血栓栓塞等带瓣管道相关并发症发生,恢复顺利,均治愈出院。术后1～4月和6月以上超声检查均提示移植的管道通畅,管壁无变薄、钙化,无瘤样扩张,无明显肺动脉瓣返流等。结论:新型无支架生物瓣带瓣管道具有管壁弹性好、易于缝合、术后排斥反应少等优点,且有良好抗返流作用,早期疗效满意。     

Side-by-side false and true lumen stenting for recanalization of the chronically occluded right coronary artery

Subintimal or false lumen stent deployment is a rare complication of percutaneous coronary interventions. The most balloon-induced small non-flow limiting dissections heal spontaneously and can be treated medically with close observation if distal coronary flow is not compromised. However, the complex and severe flow-limiting postprocedural dissections may result in abrupt vessel closure and thrombosis, with ensuing myocardial ischemia and necrosis, and can be treated effectively by coronary stenting. It is essential to ensure that the guide-wire is in the true lumen before placing the stent in total occlusive lesions, otherwise the stent placement will impair distal coronary flow. We present here an interesting case of successful coronary recanalization despite false lumen stenting of the proximal right coronary artery followed by true lumen stenting.