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Perioperative placement of stents for relief of proximal pulmonary arterial stenoses in infants

Published online by Cambridge University Press:  07 March 2008

Narayanswami Sreeram ,
Mathias Emmel ,
Lotfi Ben Mime ,
Konrad Brockmeier  and
Gerardus Bennink
Narayanswami Sreeram*
Affiliation:
University Hospital of Cologne, Germany
Mathias Emmel
Affiliation:
University Hospital of Cologne, Germany
Lotfi Ben Mime
Affiliation:
University Hospital of Cologne, Germany
Konrad Brockmeier
Affiliation:
University Hospital of Cologne, Germany
Gerardus Bennink
Affiliation:
University Hospital of Cologne, Germany
*
Department of paediatric cardiology, University Hospital of Cologne, Kerpenerstrasse 62, 50937 Cologne. Germany. Tel: +49 221 47886301; Fax: +49 221 47886302; E-mail: [email protected]
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Abstract

Introduction

Stenoses in the pulmonary arterial system can have a significant negative impact on the early postoperative course in infants. Early recognition and aggressive management are mandatory.

Patients and methods

We describe our experience with 8 infants, with ages ranging from 3 to 9 months, weighing from 4.5 to 7.7 kilograms, who presented in the up to 18 days following construction of a shunt from the superior caval vein to the pulmonary arteries with clinical symptoms of obstructed pulmonary flow. We include also 2 infants in whom pulmonary arterial stents were implanted in the operating room. Cardiac catheterization showed significant stenoses or occlusion of the left pulmonary arteries in 9 infants, the right pulmonary arteries in 2, or the superior caval vein in 1, the investigation being prompted by the findings of supraphysiological superior caval venous pressures and systemic hypoxaemia. We implanted a variety of stents mounted on balloons ranging in diameter from 6 to 13 millimetres, with 7 placed across a newly created surgical anastomotic site.

Results

All stenoses were crossed successfully, and stents implanted satisfactorily in all patients, albeit that 1 infant suffered an acute tear of the left pulmonary artery, requiring immediate reoperation. This patient died 72 hours later due to a diffuse coagulopathy. All other patients demonstrated sustained clinical improvement following the procedure. At follow-up, 7 of the 9 survivors have progressed to completion of the Fontan circulation. Redilation of the stents was required in the interim, prior to completion of the Fontan circulation, in 4 of them. In 2 patients, the previously implanted stents were incised during the Fontan completion, permitting placement of the extracardiac Goretex conduit from the inferior caval vein to the pulmonary arteries.

Conclusions

Stents can successfully be implanted perioperatively in the pulmonary arterial system during infancy, and redilated, with improvement in clinical outcome in the majority of those with clinically relevant obstruction.

Keywords

Surgeryinfantsstents
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 2 , April 2008 , pp. 158 - 164
Copyright
Copyright © Cambridge University Press 2008

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