Stenting of arterial duct and right ventricular outflow tract as alternative to surgical shunts in children with cyanotic congenital heart defects
Abstract
Aim: Analysis of right ventricular outflow tract and arterial duct stenting used as alternative to surgical systemic to pulmonary shunts in newborns and infants with congenital heart defects and critically low pulmonary blood flow. Methods: From 7/2012 to 12/2019 15 consecutive patients aged 2-102 (median 14, IQR 8-27) days having a median weight of 3.1 (IQR 2.6-3.7) kg were treated.
In 11 patients with tetralogy of Fallot or Fallot type double-outlet right ventricle stents were implanted into the right ventricular outflow tract. In the remaining four patients (three patients with critical pulmonary valve stenosis and insufficient right ventricular capacity and one patient with extreme form of Ebstein's anomaly of the tricuspid valve) the arterial duct was stented.
Mainly coronary stents were used. Results: There was no mortality.
Eight patients survived until corrective heart surgery without need of another procedure. Three patients (20%) underwent additional palliative procedure.
Median time from right ventricular outflow tract stenting to subsequent surgical procedure was 205 (IQR 125-316) days. All four patients with stented arterial ducts were followed-up for a median of 2.8 (IQR 1.5-4.1) years and required so far no additional procedure.
There was one complication (6.7%) - minor injury of AV valve. Conclusion: Stenting of the right ventricular outflow tract and arterial duct are safe and effective alternatives to surgical shunt procedures in newborns and infants with suitable types of cyanotic congenital heart defects.