Stenting of the left pulmonary artery after palliation of hypoplastic left heart syndrome
Background Left pulmonary artery stenosis and hypoplasia is a well‐recognized complication following surgical palliation of hypoplastic left heart syndrome. These lesions produce increased after load in a circulation in series so need to be effectively treated. Methods Between 2000 and 2011, 86 pati...
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Veröffentlicht in: | Catheterization and cardiovascular interventions 2016-08, Vol.88 (2), p.225-232 |
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description | Background
Left pulmonary artery stenosis and hypoplasia is a well‐recognized complication following surgical palliation of hypoplastic left heart syndrome. These lesions produce increased after load in a circulation in series so need to be effectively treated.
Methods
Between 2000 and 2011, 86 patients after surgical palliation for hypoplastic left heart syndrome had left pulmonary artery stents implanted. Median age at implantation was 4.7(1.3–15.2) years and median weight was 16.4(9.3–55.2) kg. Uncovered peripheral vascular stents were implanted (median diameter 10(8–15) mm). This is a retrospective review of the incidence of in‐stent restenosis over the medium to long term.
Results
During primary stenting procedures, there were 2/88(2.3%) major complications of stent migration with no stroke or mortality. Follow‐up was for a median period of 4.1(0.5–13.4) years. Follow‐up catheter procedures were performed after a median time of 2.3(0.02–9.6) years in 59 patients (68.6%). 55/59(93.2%) had at most mild restenosis (≤10% loss of stent lumen) and 47/59(79.6%) had no evidence of any restenosis at all caused by neointimal in‐growth. Freedom from reintervention was 77% at 5 years including stent dilation to compensate for somatic growth. Freedom from reintervention for restenosis was 93% at 5 years. Restenosis was successfully treated with standard balloon angioplasty or restenting. There was only 1/94 (1.1%) major complication in the follow‐up catheterizations of stent embolization with successful transcatheter retrieval.
Conclusions
Stenting of the left pulmonary artery after Norwood/Fontan palliation is safe and effective. Stents can be redilated to match somatic growth. The incidence of neointimal proliferation is extremely low and can be addressed by balloon dilation or stent implantation. © 2016 Wiley Periodicals, Inc. |
doi_str_mv | 10.1002/ccd.26450 |
format | Article |
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Left pulmonary artery stenosis and hypoplasia is a well‐recognized complication following surgical palliation of hypoplastic left heart syndrome. These lesions produce increased after load in a circulation in series so need to be effectively treated.
Methods
Between 2000 and 2011, 86 patients after surgical palliation for hypoplastic left heart syndrome had left pulmonary artery stents implanted. Median age at implantation was 4.7(1.3–15.2) years and median weight was 16.4(9.3–55.2) kg. Uncovered peripheral vascular stents were implanted (median diameter 10(8–15) mm). This is a retrospective review of the incidence of in‐stent restenosis over the medium to long term.
Results
During primary stenting procedures, there were 2/88(2.3%) major complications of stent migration with no stroke or mortality. Follow‐up was for a median period of 4.1(0.5–13.4) years. Follow‐up catheter procedures were performed after a median time of 2.3(0.02–9.6) years in 59 patients (68.6%). 55/59(93.2%) had at most mild restenosis (≤10% loss of stent lumen) and 47/59(79.6%) had no evidence of any restenosis at all caused by neointimal in‐growth. Freedom from reintervention was 77% at 5 years including stent dilation to compensate for somatic growth. Freedom from reintervention for restenosis was 93% at 5 years. Restenosis was successfully treated with standard balloon angioplasty or restenting. There was only 1/94 (1.1%) major complication in the follow‐up catheterizations of stent embolization with successful transcatheter retrieval.
Conclusions
Stenting of the left pulmonary artery after Norwood/Fontan palliation is safe and effective. Stents can be redilated to match somatic growth. The incidence of neointimal proliferation is extremely low and can be addressed by balloon dilation or stent implantation. © 2016 Wiley Periodicals, Inc.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.26450</identifier><identifier>PMID: 26916557</identifier><identifier>CODEN: CARIF2</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Adolescent ; Angiography ; Angioplasty, Balloon - adverse effects ; Angioplasty, Balloon - instrumentation ; Arterial Occlusive Diseases - diagnostic imaging ; Arterial Occlusive Diseases - etiology ; Arterial Occlusive Diseases - physiopathology ; Arterial Occlusive Diseases - therapy ; cardiac catheterization ; Child ; Child, Preschool ; Constriction, Pathologic ; Disease-Free Survival ; Female ; Fontan Procedure - adverse effects ; Humans ; hypoplastic left heart syndrome ; Hypoplastic Left Heart Syndrome - diagnosis ; Hypoplastic Left Heart Syndrome - physiopathology ; Hypoplastic Left Heart Syndrome - surgery ; Infant ; Male ; Norwood Procedures - adverse effects ; Palliative Care ; Pulmonary arteries ; pulmonary artery ; Pulmonary Artery - physiopathology ; Recurrence ; Retreatment ; Retrospective Studies ; Risk Factors ; Stents ; Time Factors ; Treatment Outcome ; Veins & arteries</subject><ispartof>Catheterization and cardiovascular interventions, 2016-08, Vol.88 (2), p.225-232</ispartof><rights>2016 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4940-712c2ffa936862dc26d093d37babc9d34f37c2bf5a4f2623f7daa8cb141aac6f3</citedby><cites>FETCH-LOGICAL-c4940-712c2ffa936862dc26d093d37babc9d34f37c2bf5a4f2623f7daa8cb141aac6f3</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.26450$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.26450$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26916557$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Noonan, Patrick</creatorcontrib><creatorcontrib>Kudumula, Vikram</creatorcontrib><creatorcontrib>Anderson, Ben</creatorcontrib><creatorcontrib>Ramchandani, Bharat</creatorcontrib><creatorcontrib>Miller, Paul</creatorcontrib><creatorcontrib>Dhillon, Rami</creatorcontrib><creatorcontrib>Mehta, Chetan</creatorcontrib><creatorcontrib>Stumper, Oliver</creatorcontrib><title>Stenting of the left pulmonary artery after palliation of hypoplastic left heart syndrome</title><title>Catheterization and cardiovascular interventions</title><addtitle>Cathet. Cardiovasc. Intervent</addtitle><description>Background
Left pulmonary artery stenosis and hypoplasia is a well‐recognized complication following surgical palliation of hypoplastic left heart syndrome. These lesions produce increased after load in a circulation in series so need to be effectively treated.
Methods
Between 2000 and 2011, 86 patients after surgical palliation for hypoplastic left heart syndrome had left pulmonary artery stents implanted. Median age at implantation was 4.7(1.3–15.2) years and median weight was 16.4(9.3–55.2) kg. Uncovered peripheral vascular stents were implanted (median diameter 10(8–15) mm). This is a retrospective review of the incidence of in‐stent restenosis over the medium to long term.
Results
During primary stenting procedures, there were 2/88(2.3%) major complications of stent migration with no stroke or mortality. Follow‐up was for a median period of 4.1(0.5–13.4) years. Follow‐up catheter procedures were performed after a median time of 2.3(0.02–9.6) years in 59 patients (68.6%). 55/59(93.2%) had at most mild restenosis (≤10% loss of stent lumen) and 47/59(79.6%) had no evidence of any restenosis at all caused by neointimal in‐growth. Freedom from reintervention was 77% at 5 years including stent dilation to compensate for somatic growth. Freedom from reintervention for restenosis was 93% at 5 years. Restenosis was successfully treated with standard balloon angioplasty or restenting. There was only 1/94 (1.1%) major complication in the follow‐up catheterizations of stent embolization with successful transcatheter retrieval.
Conclusions
Stenting of the left pulmonary artery after Norwood/Fontan palliation is safe and effective. Stents can be redilated to match somatic growth. The incidence of neointimal proliferation is extremely low and can be addressed by balloon dilation or stent implantation. © 2016 Wiley Periodicals, Inc.</description><subject>Adolescent</subject><subject>Angiography</subject><subject>Angioplasty, Balloon - adverse effects</subject><subject>Angioplasty, Balloon - instrumentation</subject><subject>Arterial Occlusive Diseases - diagnostic imaging</subject><subject>Arterial Occlusive Diseases - etiology</subject><subject>Arterial Occlusive Diseases - physiopathology</subject><subject>Arterial Occlusive Diseases - therapy</subject><subject>cardiac catheterization</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Constriction, Pathologic</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Fontan Procedure - adverse effects</subject><subject>Humans</subject><subject>hypoplastic left heart syndrome</subject><subject>Hypoplastic Left Heart Syndrome - diagnosis</subject><subject>Hypoplastic Left Heart Syndrome - physiopathology</subject><subject>Hypoplastic Left Heart Syndrome - surgery</subject><subject>Infant</subject><subject>Male</subject><subject>Norwood Procedures - adverse effects</subject><subject>Palliative Care</subject><subject>Pulmonary arteries</subject><subject>pulmonary artery</subject><subject>Pulmonary Artery - physiopathology</subject><subject>Recurrence</subject><subject>Retreatment</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stents</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Veins & arteries</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0ctu1DAUBmCrAtELLHgBFIkNXaT13fESDdAijaAqoJaV5Tg2k-LEqe2onbdvQqZdICGx8fHiO79k_wC8RvAEQYhPjWlOMKcM7oEDxDAuBebXz3Z3JCnfB4cp3UAIJcfyBdjHXCLOmDgAP79l2-e2_1UEV-SNLbx1uRhG34Vex22hY7bzcNMoBu19q3Mb-llvtkMYvE65NcvWxk66SNu-iaGzL8Fzp32yr3bzCPz49PH76rxcfz37vHq_Lg2VFJYCYYOd05LwiuPGYN5ASRoial0b2RDqiDC4dkxThzkmTjRaV6ZGFGltuCNH4N2SO8RwO9qUVdcmY73XvQ1jUqhCTEBKRfU_FFM6nxN9-xe9CWPsp4fMCglGGJvV8aJMDClF69QQ2276N4WgmqtRUzXqTzWTfbNLHOvONk_ysYsJnC7grvV2--8ktVp9eIwsl402ZXv_tKHjb8UFEUxdfTlTvLpYV5drqa7IA9Qdpxs</recordid><startdate>201608</startdate><enddate>201608</enddate><creator>Noonan, Patrick</creator><creator>Kudumula, Vikram</creator><creator>Anderson, Ben</creator><creator>Ramchandani, Bharat</creator><creator>Miller, Paul</creator><creator>Dhillon, Rami</creator><creator>Mehta, Chetan</creator><creator>Stumper, Oliver</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><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>201608</creationdate><title>Stenting of the left pulmonary artery after palliation of hypoplastic left heart syndrome</title><author>Noonan, Patrick ; Kudumula, Vikram ; Anderson, Ben ; Ramchandani, Bharat ; Miller, Paul ; Dhillon, Rami ; Mehta, Chetan ; Stumper, Oliver</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4940-712c2ffa936862dc26d093d37babc9d34f37c2bf5a4f2623f7daa8cb141aac6f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Angiography</topic><topic>Angioplasty, Balloon - adverse effects</topic><topic>Angioplasty, Balloon - instrumentation</topic><topic>Arterial Occlusive Diseases - diagnostic imaging</topic><topic>Arterial Occlusive Diseases - etiology</topic><topic>Arterial Occlusive Diseases - physiopathology</topic><topic>Arterial Occlusive Diseases - therapy</topic><topic>cardiac catheterization</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Constriction, Pathologic</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Fontan Procedure - adverse effects</topic><topic>Humans</topic><topic>hypoplastic left heart syndrome</topic><topic>Hypoplastic Left Heart Syndrome - diagnosis</topic><topic>Hypoplastic Left Heart Syndrome - physiopathology</topic><topic>Hypoplastic Left Heart Syndrome - surgery</topic><topic>Infant</topic><topic>Male</topic><topic>Norwood Procedures - adverse effects</topic><topic>Palliative Care</topic><topic>Pulmonary arteries</topic><topic>pulmonary artery</topic><topic>Pulmonary Artery - physiopathology</topic><topic>Recurrence</topic><topic>Retreatment</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stents</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Noonan, Patrick</creatorcontrib><creatorcontrib>Kudumula, Vikram</creatorcontrib><creatorcontrib>Anderson, Ben</creatorcontrib><creatorcontrib>Ramchandani, Bharat</creatorcontrib><creatorcontrib>Miller, Paul</creatorcontrib><creatorcontrib>Dhillon, Rami</creatorcontrib><creatorcontrib>Mehta, Chetan</creatorcontrib><creatorcontrib>Stumper, Oliver</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><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Noonan, Patrick</au><au>Kudumula, Vikram</au><au>Anderson, Ben</au><au>Ramchandani, Bharat</au><au>Miller, Paul</au><au>Dhillon, Rami</au><au>Mehta, Chetan</au><au>Stumper, Oliver</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stenting of the left pulmonary artery after palliation of hypoplastic left heart syndrome</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Cathet. Cardiovasc. Intervent</addtitle><date>2016-08</date><risdate>2016</risdate><volume>88</volume><issue>2</issue><spage>225</spage><epage>232</epage><pages>225-232</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><coden>CARIF2</coden><abstract>Background
Left pulmonary artery stenosis and hypoplasia is a well‐recognized complication following surgical palliation of hypoplastic left heart syndrome. These lesions produce increased after load in a circulation in series so need to be effectively treated.
Methods
Between 2000 and 2011, 86 patients after surgical palliation for hypoplastic left heart syndrome had left pulmonary artery stents implanted. Median age at implantation was 4.7(1.3–15.2) years and median weight was 16.4(9.3–55.2) kg. Uncovered peripheral vascular stents were implanted (median diameter 10(8–15) mm). This is a retrospective review of the incidence of in‐stent restenosis over the medium to long term.
Results
During primary stenting procedures, there were 2/88(2.3%) major complications of stent migration with no stroke or mortality. Follow‐up was for a median period of 4.1(0.5–13.4) years. Follow‐up catheter procedures were performed after a median time of 2.3(0.02–9.6) years in 59 patients (68.6%). 55/59(93.2%) had at most mild restenosis (≤10% loss of stent lumen) and 47/59(79.6%) had no evidence of any restenosis at all caused by neointimal in‐growth. Freedom from reintervention was 77% at 5 years including stent dilation to compensate for somatic growth. Freedom from reintervention for restenosis was 93% at 5 years. Restenosis was successfully treated with standard balloon angioplasty or restenting. There was only 1/94 (1.1%) major complication in the follow‐up catheterizations of stent embolization with successful transcatheter retrieval.
Conclusions
Stenting of the left pulmonary artery after Norwood/Fontan palliation is safe and effective. Stents can be redilated to match somatic growth. The incidence of neointimal proliferation is extremely low and can be addressed by balloon dilation or stent implantation. © 2016 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>26916557</pmid><doi>10.1002/ccd.26450</doi><tpages>8</tpages></addata></record> |
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subjects | Adolescent Angiography Angioplasty, Balloon - adverse effects Angioplasty, Balloon - instrumentation Arterial Occlusive Diseases - diagnostic imaging Arterial Occlusive Diseases - etiology Arterial Occlusive Diseases - physiopathology Arterial Occlusive Diseases - therapy cardiac catheterization Child Child, Preschool Constriction, Pathologic Disease-Free Survival Female Fontan Procedure - adverse effects Humans hypoplastic left heart syndrome Hypoplastic Left Heart Syndrome - diagnosis Hypoplastic Left Heart Syndrome - physiopathology Hypoplastic Left Heart Syndrome - surgery Infant Male Norwood Procedures - adverse effects Palliative Care Pulmonary arteries pulmonary artery Pulmonary Artery - physiopathology Recurrence Retreatment Retrospective Studies Risk Factors Stents Time Factors Treatment Outcome Veins & arteries |
title | Stenting of the left pulmonary artery after palliation of hypoplastic left heart syndrome |
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