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Endovascular stents for relief of cyanosis in single‐ventricle patients with shunt or conduit‐dependent pulmonary blood flow
Author(s) -
Petit Christopher J.,
Gillespie Matthew J.,
Kreutzer Jacqueline,
Rome Jonathan J.
Publication year - 2006
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20851
Subject(s) - medicine , angioplasty , surgery , ventricle , stenosis , stent , pulmonary artery , cardiology , shunt (medical) , cardiac catheterization , balloon dilation , balloon
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. © 2006 Wiley‐Liss, Inc.