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Implantation of stents as an alternative to reoperation in neonates and infants with acute complications after surgical creation of a systemic-to-pulmonary arterial shunt

Published online by Cambridge University Press:  05 February 2008

Michael Kaestner ,
Ronald P. Handke ,
Joachim Photiadis ,
Matthias Sigler  and
Martin B.E. Schneider
Michael Kaestner*
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Asklepiosklinik St. Augustin GmbH, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
Ronald P. Handke
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Asklepiosklinik St. Augustin GmbH, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
Joachim Photiadis
Affiliation:
Department of Thoracic and Cardiac Surgery, Asklepiosklinik St. Augustin GmbH, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
Matthias Sigler
Affiliation:
Department of Pediatric Cardiology and Intensive Care, Georg August Universität Göttingen, Heart Center, Göttingen, Germany
Martin B.E. Schneider
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Asklepiosklinik St. Augustin GmbH, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
*
Correspondence to: Dr med. Michael Kaestner, Asklepiosklinik St. Augustin GmbH, Deutsches Kinderherzzentrum, Department of Pediatric Cardiology and Congenital Heart Disease, Arnold Janssen Straße 29, 53757 Sankt Augustin, Germany. Tel: +49-2241-249650; Fax: +49-2241-249652; E-mail: m.kaestner@asklepios.com
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Abstract

Creation of a systemic-to-pulmonary shunt is still the firstline treatment in neonates with duct-dependent pulmonary circulation, or in patients with hypoplastic left heart syndrome as a part of the first stage of the Norwood sequence. Acute complications after such surgery, such as stenosis, thrombosis, or kinking, are potentially lifethreatening. These complications require immediate revision or exchange of the shunt. In this report, we discuss interventional treatment as an alternative to surgery in 5 patients with acute stenosis or complete occlusion of a shunt.

The age of the patients ranged from 12 to 62 days, with a median of 30 days, and their weights ranged between 2.2 and 4.6 kilogrammes, with a median of 3.2 kilogrammes. In 3 patients, the shunts were central or of modified Blalock-Taussig type, while the 2 patients with hypoplastic left heart syndrome had shunts from the right ventricle to the pulmonary arteries. We implanted 6 coronary arterial and 2 peripheral stent systems. The diameter of the balloon used for implantation had a ratio to the shunt of 0.9. to 1.

All shunts were successfully reopened by stenting. During follow-up, 3 patients underwent further procedures on an elective basis. We have one patient on the waiting list for further surgical intervention, but one patient died of septicaemia unrelated to the interventional procedure one month after implantation.

In our limited experience, implantation of stents is an effective and long-lasting treatment for complications of shunts in an emergency situation.

Keywords

Congenital heart diseaseheart surgerycatheterizationcyanosis
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 2 , April 2008 , pp. 177 - 184
Copyright
Copyright © Cambridge University Press 2008

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