Transcatheter stenting of the systemic-to-pulmonary artery shunt: A 7-year experience from a single tertiary center
Background Systemic‐to‐pulmonary artery shunt (SPS) dysfunction can be deleterious in shunt dependent patients and traditionally have undergone surgical revision. Data on transcatheter stenting of SPS is limited. We sought to evaluate feasibility, safety and outcomes of stenting SPS. Methods Retrosp...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2015-09, Vol.86 (3), p.454-462 |
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| creator | Vaughn, Gabrielle R. Moore, John W. Mallula, Kiran K. Lamberti, John J. El-Said, Howaida G. |
| description | Background
Systemic‐to‐pulmonary artery shunt (SPS) dysfunction can be deleterious in shunt dependent patients and traditionally have undergone surgical revision. Data on transcatheter stenting of SPS is limited. We sought to evaluate feasibility, safety and outcomes of stenting SPS.
Methods
Retrospective review of all patients who underwent transcatheter SPS stenting from 1/2006 to 12/2013.
Results
Of 229 surgically implanted SPS, 25 transcatheter stent interventions were performed in 22 patients. The majority had pulmonary atresia (n = 9) or HLHS (n = 10). Their median age was 4 ms (range 10 days to 4 years) and median weight 4.9 kg (range 3–14). Nine had a central and 15 had a BT shunt with a median shunt size of 3.75 mm (range 3–6). The interval from shunt placement to intervention was 1.9 ms (range 4 days–3.8 years). The indication for intervention was increasing cyanosis in10 patients and delaying final repair in 9. Two patients were on ECMO at the time of intervention. The median shunt diameter increased from 2.3 to 4.1 mm and oxygen saturation from 72 to 85% (P |
| doi_str_mv | 10.1002/ccd.25926 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1704345179</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3778112481</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4616-77d13213ff793a4b64919ceabd4aedd680352d8daf479ce5ce792b073ceab5da3</originalsourceid><addsrcrecordid>eNp1kc1OGzEUha2KqqFpF30BZIkNXQz43xl2aGiSShHdgKi6sRz7DgzMT7BnVObt65DAohIrW1ff-eTrg9A3Sk4pIezMOX_KZM7UB3RIJWOZZur3wf5Oc6Em6HOMD4SQXLH8E5owORNqRtkhitfBttHZ_h56CDj20PZVe4e7EqcRjmOaNJXL-i7bDHXTtTaM2IbEjjjeD21_ji-wzkawAcPzBkIFrQNchq7BFsekqgEnuq-2QZfsEL6gj6WtI3zdn1N0M_9xXSyz1a_Fz-JilTmhqMq09pQzystS59yKtRI5zR3YtRcWvFczwiXzM29LodNcOtA5WxPNt4z0lk_Ryc67Cd3TALE3TRUd1LVtoRuioZoILiRN-ik6_g996IbQpte9UIQJKWWivu8oF7oYA5RmE6omLWYoMdsmTGrCvDSR2KO9cVg34N_I169PwNkO-FvVML5vMkVx-arMdokqlfL8lrDh0SjNtTS3VwuzZHJOiiU3f_g_0vOiqQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1704024555</pqid></control><display><type>article</type><title>Transcatheter stenting of the systemic-to-pulmonary artery shunt: A 7-year experience from a single tertiary center</title><source>MEDLINE</source><source>Wiley Online Library Journals</source><creator>Vaughn, Gabrielle R. ; Moore, John W. ; Mallula, Kiran K. ; Lamberti, John J. ; El-Said, Howaida G.</creator><creatorcontrib>Vaughn, Gabrielle R. ; Moore, John W. ; Mallula, Kiran K. ; Lamberti, John J. ; El-Said, Howaida G.</creatorcontrib><description>Background
Systemic‐to‐pulmonary artery shunt (SPS) dysfunction can be deleterious in shunt dependent patients and traditionally have undergone surgical revision. Data on transcatheter stenting of SPS is limited. We sought to evaluate feasibility, safety and outcomes of stenting SPS.
Methods
Retrospective review of all patients who underwent transcatheter SPS stenting from 1/2006 to 12/2013.
Results
Of 229 surgically implanted SPS, 25 transcatheter stent interventions were performed in 22 patients. The majority had pulmonary atresia (n = 9) or HLHS (n = 10). Their median age was 4 ms (range 10 days to 4 years) and median weight 4.9 kg (range 3–14). Nine had a central and 15 had a BT shunt with a median shunt size of 3.75 mm (range 3–6). The interval from shunt placement to intervention was 1.9 ms (range 4 days–3.8 years). The indication for intervention was increasing cyanosis in10 patients and delaying final repair in 9. Two patients were on ECMO at the time of intervention. The median shunt diameter increased from 2.3 to 4.1 mm and oxygen saturation from 72 to 85% (P < 0.001). No intra‐procedural complications were encountered. One patient died from aspiration (autopsy demonstrated a patent shunt), 13 progressed to repair or next stage, 6 remain palliated with shunts as they are deemed unfit for the next stage and 2 are awaiting surgery.
Conclusions
Stenting of systemic to pulmonary artery shunt is a safe and effective procedure and avoids surgical re‐intervention. It can be performed both as a rescue procedure in patients with acute shunt occlusion and as an elective procedure to palliate patients not yet suitable for subsequent corrective or staged repair. © 2015 Wiley Periodicals, Inc.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.25926</identifier><identifier>PMID: 25846812</identifier><identifier>CODEN: CARIF2</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Anticoagulants - therapeutic use ; BT shunt ; Cardiac Catheterization - methods ; Child, Preschool ; Coronary Angiography ; Female ; Heart Defects, Congenital - therapy ; Humans ; Infant ; Infant, Newborn ; Male ; Pulmonary Artery - abnormalities ; Retrospective Studies ; shunt stenosis ; shunt thrombosis ; stent ; Stents ; systemic to pulmonary artery shunt ; Treatment Outcome</subject><ispartof>Catheterization and cardiovascular interventions, 2015-09, Vol.86 (3), p.454-462</ispartof><rights>2015 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4616-77d13213ff793a4b64919ceabd4aedd680352d8daf479ce5ce792b073ceab5da3</citedby><cites>FETCH-LOGICAL-c4616-77d13213ff793a4b64919ceabd4aedd680352d8daf479ce5ce792b073ceab5da3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.25926$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.25926$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25846812$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vaughn, Gabrielle R.</creatorcontrib><creatorcontrib>Moore, John W.</creatorcontrib><creatorcontrib>Mallula, Kiran K.</creatorcontrib><creatorcontrib>Lamberti, John J.</creatorcontrib><creatorcontrib>El-Said, Howaida G.</creatorcontrib><title>Transcatheter stenting of the systemic-to-pulmonary artery shunt: A 7-year experience from a single tertiary center</title><title>Catheterization and cardiovascular interventions</title><addtitle>Cathet. Cardiovasc. Intervent</addtitle><description>Background
Systemic‐to‐pulmonary artery shunt (SPS) dysfunction can be deleterious in shunt dependent patients and traditionally have undergone surgical revision. Data on transcatheter stenting of SPS is limited. We sought to evaluate feasibility, safety and outcomes of stenting SPS.
Methods
Retrospective review of all patients who underwent transcatheter SPS stenting from 1/2006 to 12/2013.
Results
Of 229 surgically implanted SPS, 25 transcatheter stent interventions were performed in 22 patients. The majority had pulmonary atresia (n = 9) or HLHS (n = 10). Their median age was 4 ms (range 10 days to 4 years) and median weight 4.9 kg (range 3–14). Nine had a central and 15 had a BT shunt with a median shunt size of 3.75 mm (range 3–6). The interval from shunt placement to intervention was 1.9 ms (range 4 days–3.8 years). The indication for intervention was increasing cyanosis in10 patients and delaying final repair in 9. Two patients were on ECMO at the time of intervention. The median shunt diameter increased from 2.3 to 4.1 mm and oxygen saturation from 72 to 85% (P < 0.001). No intra‐procedural complications were encountered. One patient died from aspiration (autopsy demonstrated a patent shunt), 13 progressed to repair or next stage, 6 remain palliated with shunts as they are deemed unfit for the next stage and 2 are awaiting surgery.
Conclusions
Stenting of systemic to pulmonary artery shunt is a safe and effective procedure and avoids surgical re‐intervention. It can be performed both as a rescue procedure in patients with acute shunt occlusion and as an elective procedure to palliate patients not yet suitable for subsequent corrective or staged repair. © 2015 Wiley Periodicals, Inc.</description><subject>Anticoagulants - therapeutic use</subject><subject>BT shunt</subject><subject>Cardiac Catheterization - methods</subject><subject>Child, Preschool</subject><subject>Coronary Angiography</subject><subject>Female</subject><subject>Heart Defects, Congenital - therapy</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Pulmonary Artery - abnormalities</subject><subject>Retrospective Studies</subject><subject>shunt stenosis</subject><subject>shunt thrombosis</subject><subject>stent</subject><subject>Stents</subject><subject>systemic to pulmonary artery shunt</subject><subject>Treatment Outcome</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1OGzEUha2KqqFpF30BZIkNXQz43xl2aGiSShHdgKi6sRz7DgzMT7BnVObt65DAohIrW1ff-eTrg9A3Sk4pIezMOX_KZM7UB3RIJWOZZur3wf5Oc6Em6HOMD4SQXLH8E5owORNqRtkhitfBttHZ_h56CDj20PZVe4e7EqcRjmOaNJXL-i7bDHXTtTaM2IbEjjjeD21_ji-wzkawAcPzBkIFrQNchq7BFsekqgEnuq-2QZfsEL6gj6WtI3zdn1N0M_9xXSyz1a_Fz-JilTmhqMq09pQzystS59yKtRI5zR3YtRcWvFczwiXzM29LodNcOtA5WxPNt4z0lk_Ryc67Cd3TALE3TRUd1LVtoRuioZoILiRN-ik6_g996IbQpte9UIQJKWWivu8oF7oYA5RmE6omLWYoMdsmTGrCvDSR2KO9cVg34N_I169PwNkO-FvVML5vMkVx-arMdokqlfL8lrDh0SjNtTS3VwuzZHJOiiU3f_g_0vOiqQ</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Vaughn, Gabrielle R.</creator><creator>Moore, John W.</creator><creator>Mallula, Kiran K.</creator><creator>Lamberti, John J.</creator><creator>El-Said, Howaida G.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20150901</creationdate><title>Transcatheter stenting of the systemic-to-pulmonary artery shunt: A 7-year experience from a single tertiary center</title><author>Vaughn, Gabrielle R. ; Moore, John W. ; Mallula, Kiran K. ; Lamberti, John J. ; El-Said, Howaida G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4616-77d13213ff793a4b64919ceabd4aedd680352d8daf479ce5ce792b073ceab5da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Anticoagulants - therapeutic use</topic><topic>BT shunt</topic><topic>Cardiac Catheterization - methods</topic><topic>Child, Preschool</topic><topic>Coronary Angiography</topic><topic>Female</topic><topic>Heart Defects, Congenital - therapy</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Male</topic><topic>Pulmonary Artery - abnormalities</topic><topic>Retrospective Studies</topic><topic>shunt stenosis</topic><topic>shunt thrombosis</topic><topic>stent</topic><topic>Stents</topic><topic>systemic to pulmonary artery shunt</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vaughn, Gabrielle R.</creatorcontrib><creatorcontrib>Moore, John W.</creatorcontrib><creatorcontrib>Mallula, Kiran K.</creatorcontrib><creatorcontrib>Lamberti, John J.</creatorcontrib><creatorcontrib>El-Said, Howaida G.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vaughn, Gabrielle R.</au><au>Moore, John W.</au><au>Mallula, Kiran K.</au><au>Lamberti, John J.</au><au>El-Said, Howaida G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transcatheter stenting of the systemic-to-pulmonary artery shunt: A 7-year experience from a single tertiary center</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Cathet. Cardiovasc. Intervent</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>86</volume><issue>3</issue><spage>454</spage><epage>462</epage><pages>454-462</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><coden>CARIF2</coden><abstract>Background
Systemic‐to‐pulmonary artery shunt (SPS) dysfunction can be deleterious in shunt dependent patients and traditionally have undergone surgical revision. Data on transcatheter stenting of SPS is limited. We sought to evaluate feasibility, safety and outcomes of stenting SPS.
Methods
Retrospective review of all patients who underwent transcatheter SPS stenting from 1/2006 to 12/2013.
Results
Of 229 surgically implanted SPS, 25 transcatheter stent interventions were performed in 22 patients. The majority had pulmonary atresia (n = 9) or HLHS (n = 10). Their median age was 4 ms (range 10 days to 4 years) and median weight 4.9 kg (range 3–14). Nine had a central and 15 had a BT shunt with a median shunt size of 3.75 mm (range 3–6). The interval from shunt placement to intervention was 1.9 ms (range 4 days–3.8 years). The indication for intervention was increasing cyanosis in10 patients and delaying final repair in 9. Two patients were on ECMO at the time of intervention. The median shunt diameter increased from 2.3 to 4.1 mm and oxygen saturation from 72 to 85% (P < 0.001). No intra‐procedural complications were encountered. One patient died from aspiration (autopsy demonstrated a patent shunt), 13 progressed to repair or next stage, 6 remain palliated with shunts as they are deemed unfit for the next stage and 2 are awaiting surgery.
Conclusions
Stenting of systemic to pulmonary artery shunt is a safe and effective procedure and avoids surgical re‐intervention. It can be performed both as a rescue procedure in patients with acute shunt occlusion and as an elective procedure to palliate patients not yet suitable for subsequent corrective or staged repair. © 2015 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>25846812</pmid><doi>10.1002/ccd.25926</doi><tpages>9</tpages></addata></record> |
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| ispartof | Catheterization and cardiovascular interventions, 2015-09, Vol.86 (3), p.454-462 |
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| source | MEDLINE; Wiley Online Library Journals |
| subjects | Anticoagulants - therapeutic use BT shunt Cardiac Catheterization - methods Child, Preschool Coronary Angiography Female Heart Defects, Congenital - therapy Humans Infant Infant, Newborn Male Pulmonary Artery - abnormalities Retrospective Studies shunt stenosis shunt thrombosis stent Stents systemic to pulmonary artery shunt Treatment Outcome |
| title | Transcatheter stenting of the systemic-to-pulmonary artery shunt: A 7-year experience from a single tertiary center |
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