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Hybrid procedure of right ventricle outflow tract stenting in small infants with pulmonary atresia and ventricular septal defect: early and mid-term results from a single centre

Published online by Cambridge University Press:  07 February 2019

Sara Bondanza ,
Maria Grazia Calevo ,
Maria Elena Derchi ,
Francesco Santoro  and
Maurizio Marasini
Sara Bondanza*
Affiliation:
Cardio-Thoracic, Abdominal and Transplantation Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
Maria Grazia Calevo
Affiliation:
UOSD Epidemiology, Biostatistics and Committees, IRCCS Istituto Giannina Gaslini, Genoa, Italy
Maria Elena Derchi
Affiliation:
Cardio-Thoracic, Abdominal and Transplantation Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
Francesco Santoro
Affiliation:
Cardio-Thoracic, Abdominal and Transplantation Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
Maurizio Marasini
Affiliation:
Cardio-Thoracic, Abdominal and Transplantation Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
*
Author for correspondence: S. Bondanza, MD, Cardio-Thoracic, Abdominal and Transplantation Department, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, Genoa, 16147, Italy. Tel: +3901056362333; Fax: +39010383221; E-mail: bondanzasara@gmail.com, sarabondanza@gaslini.org
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Abstract

Introduction

Pulmonary atresia, ventricular septal defect, major aorto-pulmonary collateral arteries, and pulmonary arteries hypoplasia are rare and complex congenital defects that require early interventions to relieve cyanosis and enhance the growth of native pulmonary arteries. The treatment of these patients is still controversial. Surgical techniques require cardiopulmonary bypass which is poorly tolerated by small infants. Percutaneous techniques such as radiofrequency perforation can be challenging. The hybrid technique consists of perventricular stenting of the right ventricle outflow tract through medial sternotomy, to restore native pulmonary flow.

Methods

We retrospectively reviewed the cardiovascular database of our centre in order to analyse our experience in hybrid procedure. We detected six patients who underwent hybrid first approach between November 2007 and December 2015. We report our early results and mid-term outcomes.

Results

Median age at the procedure was 26 days, median weight was 3150 g, and median Nakata index was 52 mm2/m2. All procedures were successful except for one: this patient underwent a surgical shunt. No immediate and early deaths or major complications occurred and oxygen saturation levels increased in all the patients. Patients were followed up for a period of 12–103 months, and four of them underwent a procedure of unifocalisation at the mean age of 12.5 months.

Conclusions

We reported data from the largest series of patients who underwent this hybrid procedure. Our experience demonstrated encouraging results to expand the use of this approach to bridge high-risk patients with diminutive pulmonary arteries to a second step of surgical repair.

Keywords

Multi-focal pulmonary vascularisationdiminutive native pulmonary arteriesperventricular stentingright ventricle outflow tracthybrid palliation
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 3 , March 2019 , pp. 375 - 379
Copyright
© Cambridge University Press 2019 

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Footnotes

Cite this article: Bondanza S, Calevo MG, Derchi ME, Santoro F, Marasini M. (2019) Hybrid procedure of right ventricle outflow tract stenting in small infants with pulmonary atresia and ventricular septal defect: early and mid-term results from a single centre. Cardiology in the Young29: 375–379. doi: 10.1017/S1047951118002482

References

1. Griselli, M, Mc Guirk, SP, Winlaw, DS, et al. The influence of pulmonary artery morphology on the results of operations for major aortopulmonary collateral arteries and complex congenital heart defects. J Thorac Cardiovasc Surg 2004; 127: 251–258.Google Scholar
2. Løfland, GK. The management of pulmonary atresia, ventricular septal defect, and multiple aorta pulmonary collateral arteries by definitive stage repair in early infancy. Eur J Cardiothorac Surg 2000; 18: 480–486.Google Scholar
3. Nørgaard, MA, Alphonso, N, Cochrane, AD, Maenahem, S, Brizard, CP, d’Udekem, Y. Major aorto-pulmonary collateral arteries of patients with pulmonary atresia and ventricular septal defects are dilated bronchial arteries. Eur J Cardiothorac Surg 2006; 29: 653–658; [Epub 2006 Feb 17].Google Scholar
4. Reddy, VM, Petrossian, E, McElhinney, DB, Moore, P, Teitel, DF, Hanley, FL. One-stage complete unifocalization in infants: when should the ventricular septal defect be closed? J Thorac Cardiovasc Surg 1997; 113: 858–868.Google Scholar
5. Abella, RF, De la Torre, T, Mastropietro, G, Morici, N, Cipriani, A, Marcelletti, C. Primary repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: a useful approach. J Thorac Cardiovasc Surg 2004; 127: 193–202.Google Scholar
6. Cools, B, Boshoff, D, Heying, R, Rega, F, Meyns, B, Gewillig, M. Transventricular balloon dilation and stenting of the RVOT in small infants with tetralogy of Fallot with pulmonary atresia. Catheter Cardiovasc Interv 2013; 82: 260–265.Google Scholar
7. Butera, G, Abella, R, Carminati, M, Frigiola, A. Perventricular implantation of a right ventricular-to-pulmonary artery ‘conduit’. Eur Heart J 2009; 30: 2078.Google Scholar
8. Zampi, JD, Armstrong, AK, Hirsch-Romano, JC. Hybrid perventricular pulmonary valve perforation and right ventricular outflow stent placement: a case report of a premature, 1.3-kg neonate with tetralogy of Fallot and pulmonary atresia. World J Pediatr Congenit Heart Surg 2014; 5: 338–341.Google Scholar
9. Nakata, S, Imay, Y, Takanashi, Y, et al. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart disease with decreased pulmonary blood flow. J Thorac Cardiovasc Surg 1984; 88: 610–619.Google Scholar
10. Marshall, AC, Love, BA, Lang, P, et al. Staged repair of tetralogy of Fallot and diminutive pulmonary arteries with a fenestrated septal defect patch. J Thorac Cardiovasc Surg 2003; 126: 1427–1433.Google Scholar
11. Sandoval, JP, Chaturvedi, RR, Benson, L, et al. Right ventricle outflow tract stenting in tetralogy of Fallot infants with high risk factors for early primary repair. Circ Cardiovasc Interv 2016; 9: e003979.Google Scholar
12. Walsh, MA, Lee, KJ, Chaturvedi, R, Van Arsdell, GS, Benson, LN. Radiofrequency perforation of the right ventricular outflow tract as a palliative strategy for pulmonary atresia with ventricular septal defect. Catheter Cardiovasc Interv 2007; 69: 1015–1020.Google Scholar
13. Gibbs, JL, Rothman, MT, Rees, MR, Parsons, JM, Blackburn, ME, Ruiz, CE. Stenting of the arterial duct: a new approach to palliation for pulmonary atresia. Br Heart J 1992; 67: 240–245.Google Scholar
14. Gladman, G, McCrindle, BW, Williams, WG, Freedom, RM, Benson, LN. The modified Blalock-Taussig shunt: clinical impact and morbidity in Fallot’s tetralogy in the current era. J Thorac Cardiovasc Surg 1997; 114: 25–30.Google Scholar
15. Di Donato, RM, Jonas, RA, Lang, P, Rome, JJ, Mayer, JE Jr, Castaneda, AR. Neonatal repair of tetralogy of Fallot with and without pulmonary atresia. J Thorac Cardiovasc Surg 1991; 101: 126–137.Google Scholar
16. Liu, Y, Xu, Y, Li, DZ, Shi, Y, Ye, M. Comparison of S 100B and NSE between cardiac surgery and interventional therapy for children. Pediatr Cardiol 2009; 30: 893–897.Google Scholar
17. Mahle, WT, Tavani, F, Zimmerman, RA, et al. An MRI study of neurological injury before and after congenital heart surgery. Circulation 2002; 106 (Suppl 1): I109–I114.Google Scholar
18. Agrawal, H, Alkashkari, W, Kenny, D. Evolution of hybrid interventions for congenital heart disease. Expert Rev Cardiovasc Ther 2017; 15: 257–266.Google Scholar
19. Dohlen, G, Chaturvedi, RR, Benson, LN, et al. Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot. Heart 2009; 95: 142–147.Google Scholar
20. Dryzek, P, Mazurek-Kula, A, Moszura, T, Sysa, A. Right ventricle outflow tract stenting as a method of palliative treatment of severe tetralogy of Fallot. Cardiovasc J 2008; 15: 376–379.Google Scholar