Stenting of aortopulmonary collaterals in complex pulmonary atresia

被引:23
作者
Redington, AN
Somerville, J
机构
[1] ROYAL BROMPTON HOSP,GROWN UP CONGENITAL HEART UNIT,LONDON SW3 6NP,ENGLAND
[2] UNIV LONDON IMPERIAL COLL SCI TECHNOL & MED,NATL HEART & LUNG INST,LONDON,ENGLAND
关键词
stents; lung; stenosis; collateral circulation;
D O I
10.1161/01.CIR.94.10.2479
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background The optimal treatment of patients with complex pulmonary atresia remains controversial. Surgical unifocalization programs are increasing popular but have not previously or currently gained universal acceptance. Furthermore, not all patients are suitable for attempts at biventricular correction. These patients may become increasingly symptomatic and require palliation. Methods and Results We attempted to palliate 12 patients with progressive symptomatic hypoxemia. Each had at least one stenotic but balloon-dilatable collateral supplying at least three lung segments. It was impossible to traverse the stenotic area with the stent in 1 patient, despite two attempts. Twelve stents were thus deployed in 11 patients. There was no effect in 1 patient who had multiple stenoses distal to the stented area. There was excellent palliation in the remainder, arterial oxygen saturation 45% to 79% before stenting (mean, 64+/-12%) rising to 67% to 90% (mean, 78+/-10%, P<.01) at discharge from hospital. One patient was referred for surgery to secure blood flow to a nearly totally occluded side branch to the right upper lobe traversed by the stent. There was an excellent symptomatic response in the remainder, with an early increase in exercise duration (P<.01). Late arterial desaturation occurred in 2 patients. In 1, there was pulmonary arterial hypertension in the lung segments supplied by the stented vessel. A stenosis had developed within the stent in the other patient, who was noncompliant with anticoagulation therapy. Conclusions Stenting of stenotic aortopulmonary collaterals can achieve excellent palliation in the majority of this highly selected subgroup of patients with complex pulmonary atresia.
引用
收藏
页码:2479 / 2484
页数:6
相关论文
共 10 条
[1]   PRESENTATION AND ATTRITION IN COMPLEX PULMONARY ATRESIA [J].
BULL, K ;
SOMERVILLE, J ;
SPIEGELHALTER, D ;
TY, E .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1995, 25 (02) :491-499
[2]  
Cullen S, 1994, AUTOPHAGY, V4, P395
[3]  
GIBBS JL, 1992, BRIT HEART J, V67, P240
[4]   INTRAVASCULAR STENT PROSTHESIS FOR RIGHT VENTRICULAR OUTFLOW OBSTRUCTION [J].
HOSKING, MCK ;
BENSON, LN ;
NAKANISHI, T ;
BURROWS, PE ;
WILLIAMS, WG ;
FREEDOM, RM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1992, 20 (02) :373-380
[5]   REPEAT DILATION OF INTRAVASCULAR STENTS IN CONGENITAL HEART-DEFECTS [J].
ING, FF ;
GRIFKA, RG ;
NIHILL, MR ;
MULLINS, CE .
CIRCULATION, 1995, 92 (04) :893-897
[6]   STAGED REPAIR OF PULMONARY ATRESIA WITH VENTRICULAR SEPTAL-DEFECT AND MAJOR SYSTEMIC TO PULMONARY-ARTERY COLLATERALS [J].
IYER, KS ;
MEE, RBB .
ANNALS OF THORACIC SURGERY, 1991, 51 (01) :65-72
[7]   USE OF ENDOVASCULAR STENTS IN CONGENITAL HEART-DISEASE [J].
OLAUGHLIN, MP ;
PERRY, SB ;
LOCK, JE ;
MULLINS, CE .
CIRCULATION, 1991, 83 (06) :1923-1939
[8]   STENTING OF THE ILIAC ARTERIES WITH THE PALMAZ STENT - EXPERIENCE FROM A MULTICENTER TRIAL [J].
PALMAZ, JC ;
LABORDE, JC ;
RIVERA, FJ ;
ENCARNACION, CE ;
LUTZ, JD ;
MOSS, JG .
CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, 1992, 15 (05) :291-297
[9]  
REDINGTON AN, 1994, BRIT HEART J, V72, P378
[10]  
SAWATARI K, 1989, J THORAC CARDIOV SUR, V98, P738