Balloon angioplasty in infants with aortic obstruction after the modified stage I Norwood procedure

Chessa, Massimo; Dindar, Aygün; Vettukattil, Joseph J.; Stümper, Oliver; Wright, John; Silove, Eric D.; Giovanni, Joseph De

doi:10.1067/mhj.2000.108238

Cited by 63 publications

(44 citation statements)

References 23 publications

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“…25 However, there is evidence that re-coarctation is more common in patients who undergo angioplasty rather than surgical repair. 26 For this reason, the preferred option in our center is to perform surgical repair of coarctation at the time of the BCPC.…”

Section: Vascular Anatomymentioning

confidence: 99%

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Cardiac Magnetic Resonance Imaging After Stage I Norwood Operation for Hypoplastic Left Heart Syndrome

Muthurangu

Taylor²,

Hegde³

et al. 2005

Circulation

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Background-After the Norwood operation, a patient's suitability for proceeding to a bidirectional cavopulmonary connection (BCPC) is assessed by a combination of echocardiography and diagnostic cardiac catheterization. In this study, we describe the results of 37 patients who underwent cardiovascular magnetic resonance (MR) assessment before BCPC. Methods and Results-Cardiovascular MR and echocardiography were performed in 37 infants with hypoplastic left heart syndrome before BCPC, and the findings were compared with surgical findings. MR assessment of ventricular function and valvar regurgitation were compared with echocardiography. MR exhibited high sensitivity and specificity for identification of neoaortic (sensitivity 86%, specificity 97%) and left pulmonary artery (sensitivity 100%, specificity 94%) obstruction. Echocardiography exhibited poor sensitivity for identification of vascular stenosis. The mean right ventricular ejection fraction calculated from the MR data was 50Ϯ10%.

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Section: Vascular Anatomymentioning

confidence: 99%

“…25 Significant vascular obstructions must be relieved before or at the time of BCPC. Right pulmonary artery reconstruction is necessary as part of the BCPC, and thus, definition of proximal right pulmonary artery anatomy is not crucial.…”

Section: Vascular Anatomymentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging After Stage I Norwood Operation for Hypoplastic Left Heart Syndrome

Muthurangu

Taylor²,

Hegde³

et al. 2005

Circulation

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“…Re-coarctation is common in patients who have undergone a Norwood operation for hypoplastic left heart syndrome (HLHS), with a reported incidence from 11% to 37% (1)(2)(3)(4)(5)(6)(7). After the efficacy of balloon angioplasty (BA) was demonstrated for native and postoperative aortic arch obstruction, the procedure was applied to patients with HLHS (8 -12).…”

mentioning

confidence: 99%

Impact of Re-Coarctation Following the Norwood Operation on Survival in the Balloon Angioplasty Era

Zeltser

Menteer

Gaynor

et al. 2005

Journal of the American College of Cardiology

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“…In spite of the functionally right ventricular character of the single ventricle heart, it seems reasonable to consider early qualification for intervention when the direct gradient across the aortic arch/isthmus stenosis exceeds 10 mmHg [1,3,6]. This situation is justified by different physiology of the systemic right ventricle in which increased pressure overload potentially leads to the onset or progression of the tricuspid valve regurgitation.…”

Section: Discussionmentioning

confidence: 99%

“…There were 47 interventions in 38 patients after stage first Norwood operation. The main reasons for percutaneous treatment in this group were stenosis of the aortic arch/isthmus (20 patients), stenosis of the right ventricle to pulmonary artery shunt (8), stenosis of the proximal pulmonary arteries (6), and secondary restriction of the interatrial communication (4) (Figure 1). …”

Section: Patientsmentioning

confidence: 99%

Percutaneous interventions in patients with hypoplastic left heart syndrome after stage first Norwood operation

Moszura¹,

Dryżek²,

Bobkowski³

et al. 2011

pwki

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A b s t r a c tBackground: Hypoplastic left heart syndrome (HLHS) still remains a therapeutic challenge due to complex anatomical and haemodynamic abnormalities. The multistage treatment leads to consequences and complications limiting the efficacy of surgery and necessitating additional percutaneous interventions.Aim: To evaluate the type of necessary percutaneous interventions in patients after stage first Norwood operation for HLHS with a focus on different techniques and equipment and to determine the efficacy of interventional treatment.Material and methods: Between 2001 and 2010 we conducted 161 interventions in 88 patients with HLHS at all stages of palliation. We performed 47 interventions in 38 patients after stage first Norwood operation. The main reasons for percutaneous treatment in this group were as follows: stenosis of the aortic arch/isthmus (20 patients), stenosis of the Sano shunt (8), proximal pulmonary arteries stenosis (6) and secondary restriction of the atrial communication (4).Results: In the group of 20 infants with stenosis of the aortic arch/isthmus balloon angioplasty allowed widening of the stenosis from 2.87 ±0.82 mm to 5.15 ±0.82 mm (p < 0.05) and a decrease of the systolic pressure gradient between the aortic arch and the descending aorta from 29.38 ±15.40 mmHg to 7.14 ±4.28 mmHg (p < 0.05). In 1 patient a stent was implanted due to rapid recurrence of the stenosis. In the group of 8 patients with critical stenosis of the right ventricle to pulmonary artery shunt successful interventions were done in 7 infants (87%). In 5 cases (62%) percutaneous balloon angioplasty turned out to be a sufficient treatment. Two patients (25%) required implantation of a stent to the Sano shunt. Oxygen saturation increased from 52 ±12% to 75 ±4% (p = 0.002) and the diameter of the stenosis increased from 2.28 ±0.48 mm to 4.14 ±0.69 mm (p = 0.0025). Six patients after stage first of the surgical palliation required balloon angioplasty of the tight proximal pulmonary artery stenosis. The diameter of the stenosis increased from 2.33 ±0.51 mm to 3.58 ±0.49 mm (p = 0.0099); however, the decrease of the pressure gradient from 3.33 ±1.63 mmHg to 2.5 ±1.05 mmHg was statistically insignificant. Secondary restriction of the atrial communication was successfully treated in all 4 patients. The diameter of the connection increased from 4.2 ±1.15 mm to 9.9 ±3.17 mm (p = 0.0079) and left atrial pressure decreased from 19.4 ±4.1 mmHg to 13.8 ±2.4 mmHg (p = 0.0075). In half of the patients it was sufficient to perform static atrioseptostomy whereas the second half required stent implantation.Conclusions: Percutaneous interventions lead to haemodynamic stabilization prior to the next step of treatment, increase arterial oxygen saturation and decrease pulmonary arterial pressure, therefore lowering the number of required operations. Rescue interventions such as stenting of the interatrial septum or critically stenosed Sano shunt should be considered in deteriorating patients even despite the risk of complications.Key w...

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Balloon angioplasty in infants with aortic obstruction after the modified stage I Norwood procedure

Cited by 63 publications

References 23 publications

Cardiac Magnetic Resonance Imaging After Stage I Norwood Operation for Hypoplastic Left Heart Syndrome

Cardiac Magnetic Resonance Imaging After Stage I Norwood Operation for Hypoplastic Left Heart Syndrome

Impact of Re-Coarctation Following the Norwood Operation on Survival in the Balloon Angioplasty Era

Percutaneous interventions in patients with hypoplastic left heart syndrome after stage first Norwood operation

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