Initial transcatheter palliation of hypoplastic left heart syndrome

Chan, Kak‐Chen; Mashburn, C.; Boucek, Mark M.

doi:10.1002/ccd.20669

Cited by 19 publications

(14 citation statements)

References 19 publications

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“…During the procedure, standard intravenous heparin should be administered. Heparin is not routinely neutralized at the end of the procedure, but acetylsalicylic acid 1-3 mg/kg/day is often given for as long as stent patency is required [12,18,23,29], although this is certainly not evidence based. The efficacy and safety of clopidogrel 0.2 mg/kg/day in this setting still needs to be determined [23].…”

Section: Anticoagulation -Antiaggregationmentioning

confidence: 99%

“…The prestent echocardiographic evaluation may identify patients at risk: a very narrow or hypoplastic aortic arch appears to predispose for this complication. Patients with severe stenosis of the aortic isthmus may require either simultaneous stenting of the isthmus, or creation of a 'reversed shunt' between the pulmonary trunk and the aortic arch at the time of the sternotomy for bilateral banding [14,17,27,28,29].…”

Section: Restrictive Aortic Isthmusmentioning

confidence: 99%

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Stenting the neonatal arterial duct

Boshoff

Michel‐Behnke

Schranz

et al. 2007

Expert Review of Cardiovascular Therapy

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Ductal stenting in neonates with either duct-dependent pulmonary or systemic circulation has become a good alternative for the initial palliation of complex congenital heart disease. Changes of stent and catheter technology (low profile, flexible, premounted stents with good scaffolding), better patient selection and preparation, optimal interventional access and covering the complete length of the duct have significantly improved results.

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Section: Anticoagulation -Antiaggregationmentioning

confidence: 99%

Section: Restrictive Aortic Isthmusmentioning

confidence: 99%

Stenting the neonatal arterial duct

Boshoff

Michel‐Behnke

Schranz

et al. 2007

Expert Review of Cardiovascular Therapy

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“…Stenting of the ductus arteriosus was performed so that prostaglandin infusion could be discontinued and was indicated when the infant had stable hemodynamics in room air and was otherwise ready to be discharged home. The procedures for stenting of the ductus arteriosus as well as decompression of the left atrium in patients with HLHS were performed for these infants as previously described [6, 12]. The details of the internal pulmonary artery band placement and complications have been described elsewhere, but the procedure will be reviewed here [5, 6].…”

Section: Methodsmentioning

confidence: 99%

“…The pulmonary bands are self-expanding nitinol-based flow restrictors with polyester inserts. Each device has two lumens that are 2 mm in diameter located on either side of a central locking pin [6]. The devices were delivered through a 6F AGA delivery sheath using a ductus areteriosus stent delivery wire.…”

Section: Methodsmentioning

confidence: 99%

“…We employed a similar approach using surgically placed pulmonary artery bands for infants with HLHS awaiting transplant [17]. We also previously described the technical aspects, complications, and feasibility of using a catheter-based interventional palliative approach for infants with HLHS who had a prolonged wait time to transplantation [5, 6]. …”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcome of Palliation with Internal Pulmonary Artery Bands After Primary Heart Transplantation for Hypoplastic Left Heart Syndrome

et al. 2009

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The purpose of this study was to describe the long-term outcome of infants with hypoplastic left heart syndrome (HLHS) who underwent placement of internal pulmonary artery bands as part of a transcatheter palliation procedure followed by primary heart transplantation. Transcatheter palliation included stenting of the ductus arteriosus, decompression of the left atrium by atrial septostomy, and internal pulmonary artery band placement. Cardiac hemodynamics, pulmonary artery architecture, and pulmonary artery growth since transplantation are described. Nine infants with HLHS had internal pulmonary artery bands placed and underwent successful heart transplant. No infant required reconstruction of the pulmonary arteries at the time of transplant. At 1 year after transplant, all of the recipients had normal mean pulmonary artery pressure, pulmonary vascular resistance, and transpulmonary gradient. Pulmonary angiography performed at 1 year after transplant demonstrated no distortion of pulmonary artery anatomy with significant interval growth of the branch pulmonary arteries. There was 100% survival to hospital discharge after transplant in this cohort of infants. Transcatheter placement of internal pulmonary artery bands for HLHS offers protection of the pulmonary vascular bed while preserving pulmonary artery architecture and growth with good long-term outcome.

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Transcatheter Pulmonary Flow Restrictors: Current Trends and Future Perspectives

Malakan Rad,

Hijazi

2024

Cathet Cardio Intervent

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BackgroundTranscatheter Pulmonary Flow Restrictors (TPFRs) represent a significant advancement in managing pulmonary blood flow for congenital heart disease patients. However, there is a paucity of comprehensive studies addressing the diversity of these devices and identifying their critical features.AimsThis review aims to consolidate the existing knowledge on TPFRs, pinpoint crucial design and development aspects, identify gaps in current practices, and spotlight directions for future research and advancement.MethodsAn exhaustive search was conducted across multiple databases, using specific search terms related to transcatheter and percutaneous pulmonary artery banding.ResultsBetween 2005 and 2024, 82 patients were reported to have received TPFR implants, including fenestrated atrial septal defect occluders, diabolo‐shaped stents, and MVP™ Micro Vascular Plug with polytetrafluoroethylene (PTFE) membranes partially removed. Microvascular plugs were the most commonly used and the most successful devices. However, the primary complications and challenges associated with MVPs included pulmonary overflow, unprotected flow to the right upper lobe, difficulty in creating an appropriately sized fenestration, the need for device replacement due to incorrect sizing, distal migration into the right pulmonary artery, left pulmonary artery stenosis, partial device collapse, thrombosis, jailing of the right upper lobe, potential injury to the pulmonary arterial wall, as well as device fracture and infection. TPFRs can be categorized based on the duration they are designed to remain within the pulmonary artery. Strategies should be devised to enable the device's easy removal without harming the pulmonary arterial wall while also preventing embolization. The ideal device should minimize migration, embolization, thrombosis, inflammation, and endothelialization risks. It should also prevent peri‐device flow and adapt to the growth of the pulmonary artery, ensuring long‐term efficacy and safety.ConclusionThe long‐term outcomes and the potential for employing biodegradable and smart biomaterials remain areas for further investigation. Successful development of these devices requires a collaborative effort among biomaterial engineers, device developers, and interventional cardiologists.

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Initial transcatheter palliation of hypoplastic left heart syndrome

Cited by 19 publications

References 19 publications

Stenting the neonatal arterial duct

Stenting the neonatal arterial duct

Long-Term Outcome of Palliation with Internal Pulmonary Artery Bands After Primary Heart Transplantation for Hypoplastic Left Heart Syndrome

Transcatheter Pulmonary Flow Restrictors: Current Trends and Future Perspectives

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