Transcatheter creation of bidirectional cavopulmonary connections by needle punctures in two patients

Abstract

We report on two patients who received a transcatheter cavopulmonary connection by a needle puncture under deep conscious sedation. In both patients, the vessel‐to‐vessel connection was achieved by a venous access into the superior caval vein and direct needle puncture of the pulmonary artery. The two cavopulmonary anastomoses were held open by a covered stent and a bare‐metal stent, respectively.

Transcatheter implantation of covered stents serving as extravascular conduits—Proof of a CT‐based approach in three cases

“…For the perforations, we used needle punctures as a straightforward method 10 – in two cases armed with a coronary wire. Especially for long distances up to several centimeters like in Case #3, the exact steering facilities of a needle under biplane guidance had been very useful.…”

“…We used balloon dilatable covered stents because they have small introducer sheaths, offer a selection of appropriate stent lengths, and provide considerable radial force. The latter was anticipated to be necessary to keep perforated vessel walls, 10 the perforated pleura, or the left atrial wall open. Especially in Case #2, we experienced extremely firm scar tissue, which made a self‐expanding graft unlikely to be efficient.…”

“…We used balloon dilatable covered stents because they have small introducer sheaths, offer a selection of appropriate stent lengths, and provide considerable radial force. The latter was anticipated to be necessary to keep perforated vessel walls, 10…”

“…In the catheterization laboratory, the introduction of covered stents in the early 90s 5,6 revealed their ability to work similarly to conduits. They are placed into a vessel like in aortic coarctation 7 or, more rarely, they connect adjacent vessels 8–10 …”

“…aortic coarctation 7 or, more rarely, they connect adjacent vessels. [8][9][10] While surgeons use conduits to connect distant vessels under direct vision, transcatheter stent implantation is dependent on realtime imaging and relies partially on guidance by the vessel anatomy itself. Therefore, and despite the availability of different covered stents, extravascular, transcatheter connections of distant vessels has not been established yet.…”