title: Balloon expandable stents for systemic venous pathway stenosis late after Mustard's operation.
abstract: OBJECTIVE
  Description and evaluation of current experience with the use of balloon expandable stents for the relief of systemic venous pathway stenosis late after Mustard's operation.
  
  
  METHODS
  Retrospective observational study of technical procedures, angiographic, and haemodynamic findings.
  
  
  METHODS
  Twenty long term survivors of Mustard's operation for transposition of the great arteries (TGA) with angiographic evidence of systemic venous pathway narrowing.
  
  
  METHODS
  Systemic venous pathway stenoses were stented using balloon expandable Palmaz stents.
  
  
  RESULTS
  Twenty seven stents were deployed across 24 stenoses. Seventeen stents were placed in the inferior baffle (16 patients), with an increase in mean (range) minimum diameter from 9.6 (4.5-15.9) to 16.5 (11.9-22.2) mm (p = 0.007), and a reduction in mean pressure gradient from 3.1 (0-8) to 0.67 (0-3) mm Hg (p = 0.002). Eight stents were placed in the superior pathways of eight patients, with diameters widened from 9.1 (3.5-14.1) to 15.2 (8.7-19.2) mm (p = 0.018), and gradients reduced from 6.4 (2-11) to 0.9 (0-2) mm Hg (p = 0.02). Two badly deployed stents were safely withdrawn from their intracardiac positions and redeployed in the iliac vein. Transvenous pacemaker insertion was facilitated by prior stent insertion.
  
  
  CONCLUSIONS
  The use of balloon expandable stents for late systemic pathway narrowing after Mustard's operation is safe and effective. The beneficial effects of stenting are likely to be more durable than those of balloon angioplasty alone, but longer term follow up is required.
authors.affiliation: Heart Clinic, Royal Liverpool Children's Hospital, UK.
authors.forename: F A
authors.initials: FA
authors.lastname: Bu'Lock
authors.forename: A J
authors.initials: AJ
authors.lastname: Tometzki
authors.forename: D J
authors.initials: DJ
authors.lastname: Kitchiner
authors.forename: R
authors.initials: R
authors.lastname: Arnold
authors.forename: I
authors.initials: I
authors.lastname: Peart
authors.forename: K P
authors.initials: KP
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D000328:Adult; D002404:Catheterization; D002932:Cineangiography; D017079:Exercise Tolerance; D006801:Humans; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D014680:Veins / Q000601:surgery*