Right ventricular outflow stent implantation: an alternative to palliative surgical relief of infundibular pulmonary stenosis.
OBJECTIVE
Preliminary assessment of the use of stents for palliative relief of right ventricular infundibular stenosis as an alternative to palliative surgical ventricular outflow enlargement.


METHODS
Descriptive clinical study.


METHODS
Four patients with right ventricular outflow obstruction, aged between 2 and 15 years. One had had previous palliative surgery for pulmonary atresia, one had hypoplastic pulmonary arteries after palliative surgery for tetralogy of Fallot, one had multiple congenital abnormalities, and one had hypertrophic cardiomyopathy.


METHODS
Tertiary paediatric cardiac centre.


METHODS
After initial echocardiographic diagnosis the extent of right ventricular outflow obstruction was assessed by angiography. Balloon expandable stainless steel stents (Johnson & Johnson) were deployed in the right ventricular infundibulum.


METHODS
Improvement in right ventricular outflow assessed by ventriculography and change in right ventricular/ left ventricular pressure ratio, change in systemic oxygen saturation, freedom from arrhythmias, and sustained improvement in echocardiographic indices of obstruction.


RESULTS
Mean right to left ventricular pressure ratio fell from 0.95 to 0.35 in the three patients with intact ventricular septum. Oxygen saturation increased from 76% to 91% in the patient with tetralogy. No arrhythmias were detected. Improvement was maintained at mean follow up of 9.7 months in three cases, but one patient required stent enlargement 17 months later because of neoendothelial proliferation within the stent.


CONCLUSIONS
Stent implantation provides an effective alternative to palliative surgical enlargement of the right ventricular infundibulum. Neoendothelial proliferation causes reduction in lumen in some cases, but this may respond to redilatation.
Gibbs
J L
JL
Department of Paediatric Cardiology, Killingbeck Hospital, Leeds, West Yorkshire.
Uzun
O
O
Blackburn
M E
ME
Parsons
J M
JM
Dickinson
D F
DF
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D010166:Palliative Care; D011666:Pulmonary Valve Stenosis / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome