Document Detail


Transcatheter occlusion of antegrade pulmonary flow in children after cavopulmonary anastomosis.
MedLine Citation:
PMID:  19021287     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To report our experience with transcatheter occlusion of antegrade pulmonary blood flow (APF) for postoperative complications of cavopulmonary anastomosis (BCPA). BACKGROUND: It has been suggested that limited APF enhances pulmonary arterial growth in patients undergoing BCPA. However, APF may result in suboptimal postoperative hemodynamics and sequelae such as SVC syndrome or prolonged chest tube drainage. For this subgroup, closure of APF may alleviate these problems. METHODS: All BCPA procedures where APF was left open from 1995-2005 were reviewed. Symptomatic patients with APF who underwent a cardiac catheterization in the postoperative period comprised the study cohort. RESULTS: 179 BCPA procedures were performed during the study period. APF was left patent in 29/179. 6/29 patients (age 10-28 months, median 14 months) presented 12 to 130 day; (median 31 days) with persistent pleural effusions (5) or SVC syndrome (1, Five had a history of a previous pulmonary arterial band (PAB) and one pulmonary stenosis. PA pressure was elevated in all (range 17-27 mmHg; median 22 mmHg). Hemodynamic evaluation with temporary APF occlusion was repeated in all patients. APF was successfully closed in 4/6 patients. The Amplatzer POA occluder was used in 3 and the Amplatzer ASD occluder in 1. Pulmonary effusions resolved in all the patients who had transcatheter APF closure as did the case of SVC syndrome. There were no complications. CONCLUSION: Transcatheter APF occlusion seems both safe and feasible in patients with hemodynamic compromise following BCPA with residual APF. Temporary occlusion testing prior to permanent device closure is recommended.
Authors:
Alejandro Torres; Robert Gray; Robert H Pass
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  72     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-01     Completed Date:  2009-02-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  988-93     Citation Subset:  IM    
Copyright Information:
Copyright 2008 Wiley-Liss, Inc.
Affiliation:
Division of Pediatric Cardiology, Columbia University College of Physicians and Surgeons, New York, New York, USA. ajtorres@mac.com
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MeSH Terms
Descriptor/Qualifier:
Balloon Occlusion* / instrumentation
Blood Pressure
Child, Preschool
Equipment Design
Heart Bypass, Right / adverse effects*
Heart Catheterization* / instrumentation
Heart Defects, Congenital / physiopathology,  surgery*
Hemodynamics*
Humans
Infant
Pleural Effusion / etiology,  physiopathology,  radiography,  therapy*
Pulmonary Artery / physiopathology
Pulmonary Circulation*
Retrospective Studies
Superior Vena Cava Syndrome / etiology,  physiopathology,  radiography,  therapy*
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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