Stenting of stenosed aortopulmonary collaterals and shunts for palliation of pulmonary atresia/ventricular septal defect

• Published in: Catheterization and cardiovascular interventions Vol. 49; no. 4; pp. 430 - 436
• Main Authors: El-Said, Howaida G., Clapp, Sandra, Fagan, Thomas E., Conwell, Jeffrey, Nihill, Michael R.
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 01.04.2000; Wiley-Liss
• Subjects: Adult; Angiography; aortopulmonary collaterals; Biological and medical sciences; Cardiology. Vascular system; Child; Collateral Circulation - physiology; congenital heart disease; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Constriction, Pathologic - diagnostic imaging; Constriction, Pathologic - therapy; DiGeorge Syndrome - diagnostic imaging; DiGeorge Syndrome - therapy; Female; Heart; Heart Septal Defects, Ventricular - diagnostic imaging; Heart Septal Defects, Ventricular - therapy; Humans; Hypoxia - diagnostic imaging; Hypoxia - therapy; Lung - blood supply; Male; Medical sciences; Palliative Care; Pulmonary Artery - abnormalities; Pulmonary Artery - diagnostic imaging; Pulmonary Atresia - diagnostic imaging; Pulmonary Atresia - therapy; pulmonary atresia/VSD; shunt; stent; Stents; Human; Endoprosthesis; Ventricular septal defect; Respiratory disease; Instrumentation therapy; Cardiovascular disease; Intracardiac defect; Instrumental dilatation; Congenital disease; Pulmonary artery; Arterial disease; Vascular disease; Case study; Collateral circulation; Treatment; Malformation; Heart disease; Atresia; Technique
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/(SICI)1522-726X(200004)49:4<430::AID-CCD18>3.0.CO;2-C

Patients with unrepaired pulmonary artery atresia and ventricular septal defect (PA/VSD) depend on aortoplumonary collaterals and surgically created shunts for pulmonary blood flow. These vessels frequently develop stenoses with time, leading to hypoperfusion of lung segments and systemic hypoxemia. The purpose of this article is to describe catheter palliation of hypoxemic patients with PA/VSD who were not candidates for surgical repair. We present our experience with stent implantation for stenosis of aortopulmonary collaterals and shunts in these patients. Three patients with hypoplastic pulmonary arteries underwent stent placement in aortopulmonary collateral arteries (APCAs) or their shunts. Technical aspects of the interventional catheterization procedure are discussed in detail. Case 1 underwent placement of five stents in collateral vessels and one stent in the Blalock‐Taussig shunt (BT) with dramatic increase in vessel size and improvement in saturations from 70% to 89%. Case 2 underwent placement of two overlapping stents in a collateral vessel with an increase in diameter of the collateral vessel from 2.3 to 6 mm and an improvement in saturation from 68% to 88%. Case 3 underwent placement of three overlapping stents in a BT shunt with an increase in diameter of the shunt from 2.2 to 6.6 mm and an improvement in saturation from 71% to 89%. All three patients had excellent clinical improvement and stable saturation at follow‐up. Stent placement for maintaining patency of APCAs and aortopulmonary shunts is feasible and safe. Cathet. Cardiovasc. Intervent. 49:430–436, 2000. © 2000 Wiley‐Liss, Inc.