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Native right ventricular outflow tract stenting in a child with tetralogy of fallot and absent left pulmonary artery.

Molaei A, Meraji M, Malakan Rad E - Iran J Pediatr (2013)

View Article: PubMed Central - PubMed

Affiliation: Rajaei Cardiovascular & Medical Research Center, Pediatric Cardiology Department, Iran University of Medical Sciences.

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Although percutaneous placement of intravascular stents in congenital heart disease is a common practice, there are few reports regarding native right ventricular outflow tract (RVOT) stenting in children... The indications for RVOT stenting are RV-to-PA conduit stenosis, residual infundibular stenosis after intracardiac repair, TOF with hypoplastic branch pulmonary arteries after palliative shunt surgery, pulmonary atresia after perforation of atretic segment, and RV hypertrophic cardiomyopathy and also as a bridge to surgery... RVOT stenting in such patients theoretically can lead to two major problems: overflow and edema of the right lung with resultant vasculopathy in the long term, and free pulmonary valve regurgitation with its consequences that include right ventricular dilatation and dysfunction... In our case, none of these complications occurred, because we chose the stent size with scrutiny and we did not sacrifice the pulmonary valve... To our knowledge the patient has not undergone any curative operation by now... RVOT stenting provides an effective palliative modality for children with TOF and unfavorable pulmonary artery anatomy... In high risk patients such as our patient with severe cyanosis and high hemoglobin level and blood viscosity, the RVOT stenting decreases perioperative morbidity and mortality... In conclusion native RVOT stenting is an effective and safe procedure in appropriately selected patients, especially in whom total correction is not possible... This procedure causes better growth of pulmonary artery branches, decreases right ventricular hypertrophy and increases left ventricular volume... Although many of these stents cannot be dilated to adult size, their efficacy in small infants and children in whom further surgery will ultimately be required is remarkable.

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Right ventricular injection in anteroposterior view shows severe right ventricular outflow tract stenosis and absent left pulmonary artery
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Figure 1: Right ventricular injection in anteroposterior view shows severe right ventricular outflow tract stenosis and absent left pulmonary artery

Mentions: EKG revealed normal sinus rhythm, right axis deviation and severe right ventricular hypertrophy (RVH). Echocardiography showed TOF anatomy, severe RVOT stenosis with 75 mmHg pressure gradient, RVH, abscent left pulmonary artery branch (LPA), non-functioning previous MBT shunts and major collateral arteries originating from descending aorta. On catheterization, both previous MBT shunts were occluded, the right pulmonary artery (RPA) was small with fairly acceptable arborization. Left lung was supplied by major collateral arteries originating from descending aorta and severe RVOT stenosis was present (Fig. 1). RVOT stenting was performed by two consecutive stents (17×7 mm Express LD, Boston Scientific. USA and 18×5 mm Racer renal stents, Medtronic USA). Post stenting angiography showed significant increase in pulmonary blood flow to the right lung (Fig. 2).


Native right ventricular outflow tract stenting in a child with tetralogy of fallot and absent left pulmonary artery.

Molaei A, Meraji M, Malakan Rad E - Iran J Pediatr (2013)

Right ventricular injection in anteroposterior view shows severe right ventricular outflow tract stenosis and absent left pulmonary artery
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4359597&req=5

Figure 1: Right ventricular injection in anteroposterior view shows severe right ventricular outflow tract stenosis and absent left pulmonary artery
Mentions: EKG revealed normal sinus rhythm, right axis deviation and severe right ventricular hypertrophy (RVH). Echocardiography showed TOF anatomy, severe RVOT stenosis with 75 mmHg pressure gradient, RVH, abscent left pulmonary artery branch (LPA), non-functioning previous MBT shunts and major collateral arteries originating from descending aorta. On catheterization, both previous MBT shunts were occluded, the right pulmonary artery (RPA) was small with fairly acceptable arborization. Left lung was supplied by major collateral arteries originating from descending aorta and severe RVOT stenosis was present (Fig. 1). RVOT stenting was performed by two consecutive stents (17×7 mm Express LD, Boston Scientific. USA and 18×5 mm Racer renal stents, Medtronic USA). Post stenting angiography showed significant increase in pulmonary blood flow to the right lung (Fig. 2).

View Article: PubMed Central - PubMed

Affiliation: Rajaei Cardiovascular & Medical Research Center, Pediatric Cardiology Department, Iran University of Medical Sciences.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Although percutaneous placement of intravascular stents in congenital heart disease is a common practice, there are few reports regarding native right ventricular outflow tract (RVOT) stenting in children... The indications for RVOT stenting are RV-to-PA conduit stenosis, residual infundibular stenosis after intracardiac repair, TOF with hypoplastic branch pulmonary arteries after palliative shunt surgery, pulmonary atresia after perforation of atretic segment, and RV hypertrophic cardiomyopathy and also as a bridge to surgery... RVOT stenting in such patients theoretically can lead to two major problems: overflow and edema of the right lung with resultant vasculopathy in the long term, and free pulmonary valve regurgitation with its consequences that include right ventricular dilatation and dysfunction... In our case, none of these complications occurred, because we chose the stent size with scrutiny and we did not sacrifice the pulmonary valve... To our knowledge the patient has not undergone any curative operation by now... RVOT stenting provides an effective palliative modality for children with TOF and unfavorable pulmonary artery anatomy... In high risk patients such as our patient with severe cyanosis and high hemoglobin level and blood viscosity, the RVOT stenting decreases perioperative morbidity and mortality... In conclusion native RVOT stenting is an effective and safe procedure in appropriately selected patients, especially in whom total correction is not possible... This procedure causes better growth of pulmonary artery branches, decreases right ventricular hypertrophy and increases left ventricular volume... Although many of these stents cannot be dilated to adult size, their efficacy in small infants and children in whom further surgery will ultimately be required is remarkable.

No MeSH data available.


Related in: MedlinePlus