Document Detail

Perioperative placement of stents for relief of proximal pulmonary arterial stenoses in infants.
MedLine Citation:
PMID:  18325139     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Stenoses in the pulmonary arterial system can have a significant negative impact on the early postoperative course in infants. Early recognition and aggressive management are mandatory. PATIENTS AND METHODS: We describe our experience with 8 infants, with ages ranging from 3 to 9 months, weighing from 4.5 to 7.7 kilograms, who presented in the up to 18 days following construction of a shunt from the superior caval vein to the pulmonary arteries with clinical symptoms of obstructed pulmonary flow. We include also 2 infants in whom pulmonary arterial stents were implanted in the operating room. Cardiac catheterization showed significant stenoses or occlusion of the left pulmonary arteries in 9 infants, the right pulmonary arteries in 2, or the superior caval vein in 1, the investigation being prompted by the findings of supraphysiological superior caval venous pressures and systemic hypoxaemia. We implanted a variety of stents mounted on balloons ranging in diameter from 6 to 13 millimetres, with 7 placed across a newly created surgical anastomotic site. RESULTS: All stenoses were crossed successfully, and stents implanted satisfactorily in all patients, albeit that 1 infant suffered an acute tear of the left pulmonary artery, requiring immediate reoperation. This patient died 72 hours later due to a diffuse coagulopathy. All other patients demonstrated sustained clinical improvement following the procedure. At follow-up, 7 of the 9 survivors have progressed to completion of the Fontan circulation. Redilation of the stents was required in the interim, prior to completion of the Fontan circulation, in 4 of them. In 2 patients, the previously implanted stents were incised during the Fontan completion, permitting placement of the extracardiac Goretex conduit from the inferior caval vein to the pulmonary arteries. CONCLUSIONS: Stents can successfully be implanted perioperatively in the pulmonary arterial system during infancy, and redilated, with improvement in clinical outcome in the majority of those with clinically relevant obstruction.
Narayanswami Sreeram; Mathias Emmel; Lotfi Ben Mime; Konrad Brockmeier; Gerardus Bennink
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Publication Detail:
Type:  Journal Article     Date:  2008-03-07
Journal Detail:
Title:  Cardiology in the young     Volume:  18     ISSN:  1047-9511     ISO Abbreviation:  Cardiol Young     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-04-10     Completed Date:  2008-09-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200019     Medline TA:  Cardiol Young     Country:  England    
Other Details:
Languages:  eng     Pagination:  158-64     Citation Subset:  IM    
Department of paediatric cardiology, University Hospital of Cologne, Germany.
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MeSH Terms
Hypoplastic Left Heart Syndrome / therapy
Palliative Care
Postoperative Complications
Pulmonary Valve Stenosis / surgery*
Treatment Outcome
Reg. No./Substance:

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