title: Transcatheter palliation of congenital heart disease with reduced pulmonary blood flow.
abstract: BACKGROUND
  Although surgical shunt is still considered as the best palliation of congenital heart disease with reduced pulmonary blood flow, stent implantation may be technically simpler, safer and more cost-effective than surgery in high-risk patients. This study evaluated the feasibility and results of this option in patients with duct-dependent pulmonary blood flow or systemic-to-pulmonary shunt malfunction.
  
  
  METHODS
  Between April 2003 and July 2004, 9 patients (age 11 days-52 years, weight 2.1-52 kg) with complex congenital heart disease underwent stent implantation inside the patent ductus arteriosus (4 patients) or a stenotic surgical shunt (5 patients).
  
  
  RESULTS
  The stenting procedure was successfully completed in all cases. The procedural time was 162 +/- 36 min (range 90-225 min). The fluoroscopy time was 33.8 +/- 6.8 min. No patient died. The morbidity rate was 22.2% (1 patient had local infection at the site of puncture and 1 had transient femoral artery pulse loss). After the procedure, the ductus/shunt diameter increased from 1.2 +/- 0.6 to 3.6 +/- 0.6 mm (p < 0.0001) and oxygen saturation improved from 74.0 +/- 6.5 to 85.2 +/- 3.3% (p < 0.01). Three patients underwent corrective surgery without technical problems after 8.0 +/- 1.0 months while oxygen saturation remained constantly >80% in patients still waiting for surgical repair (follow-up 5.3 +/- 3.1 months).
  
  
  CONCLUSIONS
  Stent implantation is a technically feasible, safe and effective palliative option in high-risk surgical patients with congenital heart disease and reduced pulmonary blood flow. Although larger series are required to define the cost-effective clinical impact of this therapeutic option, it is reasonable to hypothesize a further extension of its indication even to elective and low-risk surgical patients.
authors.affiliation: Division of Cardiology, Second University of Naples, Naples, Italy. santoropino@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santoro
authors.forename: Maurizio Cappelli
authors.initials: MC
authors.lastname: Bigazzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caianiello
authors.forename: Marianna
authors.initials: M
authors.lastname: Carrozza
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Palladino
authors.forename: Gaetano
authors.initials: G
authors.lastname: Palma
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
authors.forename: Carlo
authors.initials: C
authors.lastname: Vosa
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D001783:Blood Flow Velocity / Q000502:physiology*; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D019919:Prosthesis Implantation / Q000295:instrumentation; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome