title: Upper cavo-pulmonary anastomosis by transcatheter technique.
abstract: OBJECTIVE
  The aim of this animal study was to establish a shunt connection between superior vena cava (SVC) and right pulmonary artery (RPA) by transvascular intervention solely.
  
  
  BACKGROUND
  After initial shunt creation, the establishment of the upper cavo-pulmonary anastomosis (UCPA) is the second out of three open chest operations young infants with univentricular anatomy are subjected to. To avoid the risks of reoperation with cardiovascular bypass, we sought to replace this surgical step by an interventional technique.
  
  
  METHODS
  After cannulation of jugular and femoral veins in four piglets (mean body weight of 12.5 kg) an UCPA was created by radiofrequency perforation from the SVC across the right atrium into the RPA and subsequent implantation of covered stents. The perforation was guided by biplane fluoroscopy and the perforation wire premounted with a coaxial catheter was advanced into the distal pulmonary artery and exchanged for a stiffer wire. A long sheath was brought into the RPA and an 80 mm long expanded poly-tetra-fluoro-ethylene (ePTFE)-covered Cheatham Platinum stent was then implanted connecting the SVC with the RPA.
  
  
  RESULTS
  Immediate angiography showed antegrade flow from SVC to RPA. Angiographic re-evaluation after a median period of 4 weeks showed partial in-stent stenosis but patent lumina. Additionally, veno-venous collaterals from the SVC to the right atrium had developed. Histology of the explanted stents revealed parietal thrombi and mild to moderate pseudo intima proliferation inside the lumina.
  
  
  CONCLUSIONS
  The transvascular creation of an upper unidirectional cavo-pulmonary anastomosis in piglets is technically feasible using standard catheterization equipment.
authors.affiliation: Department of Congenital Heart Defects and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany. schmitt@dhzb.de
authors.forename: Boris
authors.initials: B
authors.lastname: Schmitt
authors.forename: Titus Mbah
authors.initials: TM
authors.lastname: Sabi
authors.forename: Matthias
authors.initials: M
authors.lastname: Sigler
authors.forename: Felix
authors.initials: F
authors.lastname: Berger
authors.forename: Peter
authors.initials: P
authors.lastname: Ewert
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D017115:Catheter Ablation; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D057785:Catheters; D049109:Cell Proliferation; D020099:Coated Materials, Biocompatible; D003097:Collateral Circulation; D004867:Equipment Design; D005240:Feasibility Studies; D005268:Femoral Vein / Q000000981:diagnostic imaging; D005471:Fluoroscopy; D018610:Heart Bypass, Right / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D018810:Magnetic Resonance Angiography; D023421:Models, Animal; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D015641:Radiography, Interventional / Q000379:methods; D015607:Stents; D013552:Swine; D013997:Time Factors; D014654:Vascular Patency; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*
chemical_list: D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene