Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-26T02:35:18.218Z Has data issue: false hasContentIssue false

Single-centre experience in stenting arterial shunts for adult CHD patients with single-ventricle physiology and pulmonary blood flow dependent on arterial shunts

Published online by Cambridge University Press:  12 October 2018

Mohamed Kasem*
Affiliation:
Department of Congenital Cardiology, Leeds General Infirmary, Leeds, UK
James Bentham
Affiliation:
Department of Congenital Cardiology, Leeds General Infirmary, Leeds, UK
John Thomson
Affiliation:
Department of Congenital Cardiology, Leeds General Infirmary, Leeds, UK
*
Author for correspondence: Dr M. Kasem, Department of Congenital Cardiology, Leeds General Infirmary, E floor Jubilee Wing, Great George Street, Leeds LS1 3EX, UK. Tel: +44 113392 7551; Fax: +44 113392 8474; E-mail: m.kasem@nhs.net

Abstract

Objectives

The objectives of this study were to describe the approach to stenting arterial shunts in adult congenital patients with single-ventricle physiology and to assess the medium-term clinical and haemodynamic outcomes following stent insertion.

Background

Adult patients with single-ventricle physiology and pulmonary blood flow dependent on a surgically placed arterial shunt who did not progress to venous palliation are extremely challenging to manage. Progressive cyanosis secondary to narrowing of the shunt has a marked impact on exercise tolerance and results in intolerable well-being for these patients. Stenting arterial shunts in adult patients is one method that can help improve pulmonary blood flow. There is very limited information in the literature about this patient.

Methods

This is a retrospective study for arterial shunts stenting conducted between 2008 and 2016. The peripheral oxygen saturations, the NYHA status, the haemoglobin, and the degree of atrio-ventricular valve regurgitation as assessed on transthoracic echo were compared before and 6–12 months after procedures.

Results

There was a short-term improvement in oxygen saturations; the pre-procedure mean was 75.8 (SD 2.55)% (range 70–85%) and post-procedure mean was 83 (SD 2.52)% (range 78–87%), with a p value of 0.04. Haemoglobin level decreased from a pre-procedure mean of 22.06–20.28 g/L 6 months post procedure (range 18.1–24.4 to 13–23.3 g/L), with a p value of 0.44. NYHA class decreased from a mean of 3.2–2.2 post procedure. Left atrial volume for four of the cases did not change (22.6–76.6 ml [mean 48.4 ml] to 29.6–72.9 ml [mean 52 ml], p value: 0.83).

Conclusions

Stenting stenotic arterial shunts is a useful method to gain a medium-term improvement on the oxygen saturation and clinical symptoms, and may act as a useful intermediate step for further management plans.

Type
Original Article
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Dancea, A, Justino, H, Martucci, G. Catheter intervention for congenital heart disease at risk of circulatory failure. Can J Cardiol 2013; 29: 786795.Google Scholar
2. Santoro, G, Bigazzi, MC, Caianiello, G, et al. Transcatheter palliation of congenital heart disease with reduced pulmonary blood flow. Ital Heart J 2005; 6: 3540.Google Scholar
3. Vaughn, GR, Moore, JW, Mallula, KK, Lamberti, JJ, El-Said, HG. Transcatheter stenting of the systemic-to-pulmonary artery shunt: a 7-year experience from a single tertiary center. Catheter Cardiovasc Interv 2015; 86: 454462.Google Scholar