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Hybrid stent implantation to the pulmonary artery from peripheral access via recruited systemic-pulmonary shunt.

Haponiuk I, Chojnicki M, Steffens M, Jaworski R, Paczkowski K, Szofer-Sendrowska A, Gierat-Haponiuk K - Postepy Kardiol Interwencyjnej (2015)

Bottom Line: The implantation of vascular stents in patients with low body weight and difficult anatomy of the stenosis needs individual cannulation strategy or a hybrid approach.Peripheral approach to LPA was possible after surgical rethoracotomy and the recruitment of a left Blalock-Taussig (BT) shunt stump.The cooperation of cardiovascular intervention with surgical approach appears a safe strategy for borderline patients referred for staged treatment of complex congenital heart defects.

View Article: PubMed Central - PubMed

Affiliation: Chair of Physiotherapy, Gdansk University of Physical Education and Sport, Gdansk, Poland ; Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.

ABSTRACT
The implantation of vascular stents in patients with low body weight and difficult anatomy of the stenosis needs individual cannulation strategy or a hybrid approach. We present a successful balloon angioplasty with direct stent implantation to severe ostial stenosis of the left pulmonary artery to xenograft anastomosis (LPA) in a 6-year-old boy late after surgical correction of pulmonary atresia with ventricular septal defect. Peripheral approach to LPA was possible after surgical rethoracotomy and the recruitment of a left Blalock-Taussig (BT) shunt stump. The cooperation of cardiovascular intervention with surgical approach appears a safe strategy for borderline patients referred for staged treatment of complex congenital heart defects.

No MeSH data available.


Related in: MedlinePlus

Control angio-CT: proper position of implanted stent to left pulmonary artery (LPA)
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Figure 0003: Control angio-CT: proper position of implanted stent to left pulmonary artery (LPA)

Mentions: The approach was left-sided posterolateral rethoracotomy with meticulous preparation of pleural adhesions and the closure of aorto-pulmonary collateral arteries (MAPCAs). A systemic-to-pulmonary shunt (Gore-Tex 4 mm, LM Gore and Associates, USA), closed by vascular clips during anatomic correction of PA-VSD, was identified parallel to the descending aorta. After removing the clips, the shunt was rinsed in 0.9% saline, and a vivid blood flow from the pulmonary artery was obtained. An arterial sheath was introduced via Blalock-Taussig (BT) shunt stump, and angiography was performed. The LPA stenosis was identified between the place of anastomosis of the xenograft conduit and the distal part of the LPA, with morphology typical for native stenosis (Figure 1). When the balloon dilatation catheter was introduced in the right position, hybrid angioplasty of the LPA was performed. The stenosis dilatation was unsatisfactory because of the elasticity of the stenotic artery. After the exchange of the balloon catheter, a vascular stent (18 mm long × 10 mm diameter, Cook, EU) was directly implanted in the right position. An effective LPA dilatation was achieved with improved blood flow to the left lung from the mean pulmonary artery (Figure 2). Local bleeding from a rapture of the LPA wall was controlled and careful haemostasis was effectively performed. Drainage of the pleural cavity was done in a routine fashion. Control transesophageal echocardiography (TEE) showed an effective blood flow to the LPA without residual pressure gradients. The correct position of the implanted stent was confirmed by an angio-computed tomography (CT) scan, performed on the 6th postoperative day before discharge (Figure 3).


Hybrid stent implantation to the pulmonary artery from peripheral access via recruited systemic-pulmonary shunt.

Haponiuk I, Chojnicki M, Steffens M, Jaworski R, Paczkowski K, Szofer-Sendrowska A, Gierat-Haponiuk K - Postepy Kardiol Interwencyjnej (2015)

Control angio-CT: proper position of implanted stent to left pulmonary artery (LPA)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372632&req=5

Figure 0003: Control angio-CT: proper position of implanted stent to left pulmonary artery (LPA)
Mentions: The approach was left-sided posterolateral rethoracotomy with meticulous preparation of pleural adhesions and the closure of aorto-pulmonary collateral arteries (MAPCAs). A systemic-to-pulmonary shunt (Gore-Tex 4 mm, LM Gore and Associates, USA), closed by vascular clips during anatomic correction of PA-VSD, was identified parallel to the descending aorta. After removing the clips, the shunt was rinsed in 0.9% saline, and a vivid blood flow from the pulmonary artery was obtained. An arterial sheath was introduced via Blalock-Taussig (BT) shunt stump, and angiography was performed. The LPA stenosis was identified between the place of anastomosis of the xenograft conduit and the distal part of the LPA, with morphology typical for native stenosis (Figure 1). When the balloon dilatation catheter was introduced in the right position, hybrid angioplasty of the LPA was performed. The stenosis dilatation was unsatisfactory because of the elasticity of the stenotic artery. After the exchange of the balloon catheter, a vascular stent (18 mm long × 10 mm diameter, Cook, EU) was directly implanted in the right position. An effective LPA dilatation was achieved with improved blood flow to the left lung from the mean pulmonary artery (Figure 2). Local bleeding from a rapture of the LPA wall was controlled and careful haemostasis was effectively performed. Drainage of the pleural cavity was done in a routine fashion. Control transesophageal echocardiography (TEE) showed an effective blood flow to the LPA without residual pressure gradients. The correct position of the implanted stent was confirmed by an angio-computed tomography (CT) scan, performed on the 6th postoperative day before discharge (Figure 3).

Bottom Line: The implantation of vascular stents in patients with low body weight and difficult anatomy of the stenosis needs individual cannulation strategy or a hybrid approach.Peripheral approach to LPA was possible after surgical rethoracotomy and the recruitment of a left Blalock-Taussig (BT) shunt stump.The cooperation of cardiovascular intervention with surgical approach appears a safe strategy for borderline patients referred for staged treatment of complex congenital heart defects.

View Article: PubMed Central - PubMed

Affiliation: Chair of Physiotherapy, Gdansk University of Physical Education and Sport, Gdansk, Poland ; Department of Pediatric Cardiac Surgery, Mikolaj Kopernik Hospital, Gdansk, Poland.

ABSTRACT
The implantation of vascular stents in patients with low body weight and difficult anatomy of the stenosis needs individual cannulation strategy or a hybrid approach. We present a successful balloon angioplasty with direct stent implantation to severe ostial stenosis of the left pulmonary artery to xenograft anastomosis (LPA) in a 6-year-old boy late after surgical correction of pulmonary atresia with ventricular septal defect. Peripheral approach to LPA was possible after surgical rethoracotomy and the recruitment of a left Blalock-Taussig (BT) shunt stump. The cooperation of cardiovascular intervention with surgical approach appears a safe strategy for borderline patients referred for staged treatment of complex congenital heart defects.

No MeSH data available.


Related in: MedlinePlus