title: Stenting of stenosed aortopulmonary collaterals and shunts for palliation of pulmonary atresia/ventricular septal defect.
abstract: Patients with unrepaired pulmonary artery atresia and ventricular septal defect (PA/VSD) depend on aortoplumonary collaterals and surgically created shunts for pulmonary blood flow. These vessels frequently develop stenoses with time, leading to hypoperfusion of lung segments and systemic hypoxemia. The purpose of this article is to describe catheter palliation of hypoxemic patients with PA/VSD who were not candidates for surgical repair. We present our experience with stent implantation for stenosis of aortopulmonary collaterals and shunts in these patients. Three patients with hypoplastic pulmonary arteries underwent stent placement in aortopulmonary collateral arteries (APCAs) or their shunts. Technical aspects of the interventional catheterization procedure are discussed in detail. Case 1 underwent placement of five stents in collateral vessels and one stent in the Blalock-Taussig shunt (BT) with dramatic increase in vessel size and improvement in saturations from 70% to 89%. Case 2 underwent placement of two overlapping stents in a collateral vessel with an increase in diameter of the collateral vessel from 2.3 to 6 mm and an improvement in saturation from 68% to 88%. Case 3 underwent placement of three overlapping stents in a BT shunt with an increase in diameter of the shunt from 2.2 to 6.6 mm and an improvement in saturation from 71% to 89%. All three patients had excellent clinical improvement and stable saturation at follow-up. Stent placement for maintaining patency of APCAs and aortopulmonary shunts is feasible and safe.
authors.affiliation: Department of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: H G
authors.initials: HG
authors.lastname: El-Said
authors.forename: S
authors.initials: S
authors.lastname: Clapp
authors.forename: T E
authors.initials: TE
authors.lastname: Fagan
authors.forename: J
authors.initials: J
authors.lastname: Conwell
authors.forename: M R
authors.initials: MR
authors.lastname: Nihill
mesh_terms: D000328:Adult; D000792:Angiography; D002648:Child; D003097:Collateral Circulation / Q000502:physiology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000628:therapy; D004062:DiGeorge Syndrome / Q000000981:diagnostic imaging / Q000628:therapy; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D000860:Hypoxia / Q000000981:diagnostic imaging / Q000628:therapy; D008168:Lung / Q000098:blood supply*; D008297:Male; D010166:Palliative Care; D011651:Pulmonary Artery / Q000002:abnormalities / Q000000981:diagnostic imaging; D018633:Pulmonary Atresia / Q000000981:diagnostic imaging / Q000628:therapy*; D015607:Stents