Stenting of Native Right Ventricular Outflow Tract Obstructions in Symptomatic Infants

Objective

To assess feasibility, safety and effectiveness of right ventricular outflow tract (RVOT) stenting in symptomatic young infants.

Methods

Multicentre evaluation of 35 patients intended to undergo RVOT stenting in 11 pediatric cardiac centres from 2009 to August 2011.

Results

Median age and weight at the time of first stent implantation were 8 weeks and 3.3 kg, with 40% of patients <3 kg. A total of 19 patients had suffered from hypoxemic spells, 8 patients were ventilated, 6 on inotropic support and 5 on prostaglandin infusion. Severe concomitant malformations were present in 11 patients, and acute infections in 2. Stenting of the RVOT was successfully performed in 33 patients, improving oxygen saturation from a median of 77 to 90% 2 days after intervention. Besides the 2 patients in whom RVOT stenting was not successful for technical reasons, there were no procedural complications. In 17 of 33 patients, 1–3 reinterventions were performed during follow‐up, less than half of those were reinterventions in the RVOT. A total of 27 patients have undergone successful surgical repair 4–162 (median 19.5) weeks after initial RVOT stent implantation, 2 patients are still waiting. There were no perioperative deaths.

Conclusions

Stenting of the RVOT provides a safe and effective management strategy for initial palliation in symptomatic young infants, including those patients not suitable or at higher risk for surgical therapy. (J Interven Cardiol 2015;28:279–287)

     

Catheter Ablation for Control of Ventricular Tachycardia: A Report of the Percutaneous Cardiac Mapping and Ablation Registry

Catheter ablation of ventricular tachycardia is a procedure of last resort in critically ill patients. The Percutaneous Cardiac Mapping and Ablation Registry was able to collect data on 88 patients undergoing ablation of ventricular tachycardia foci. The mean following interval for the group was 10 ± 8 months. Results were divided into three categories: Group I patients remained asymptomatic and were on no antiarrhythmic medications (33%); Group II remained asymptomatic and took antiarrhythmic agents (38%): Group III patients were considered unsuccessful and consisted of 29 percent of the total. More than one-third of patients received two shocks; the remainder received from one to five shocks. Overall mortality included four procedure-related deaths and total follow-up mortality was 25 percent. Catheter ablation for ventricular tachycardia should he undertaken only in highly specialized centers with an expert and experienced electrophysiologist with immediate surgical back-up available.