Öz
Objectives: Stenosis of native arteries and of surgically placed conduits is a major problem. Patients that underwent stent implantation to right sided vascular structures were retrospectively analyzed. Methods: Seventeen patients underwent 18 stent implantations between 1999 and 2010. All of the patients’ age, history of previous surgeries, anatomy of the stenotic segment and the pressure gradient were recorded. Balloon-expandable stents were implanted into pulmonary artery branches, between right ventricle and pulmonary artery, into Fontan circulation and to right ventricle outflow tract. Patients were classified into two groups clinically: those without cyanosis n = 13 and those with cyanosis n = 4 . Results: Median age and weight of the patients’ were 5 years 5 days-17 years and 18 kilograms 3.2-65 respectively. Median systolic pressure gradient mmHg decreased to 73 from 103 between right ventricle and pulmonary artery; and to 1 from 8 in pulmonary artery branches and Fontan circulation. Vessel diameters increased 2.4 times in acyanotic group. Median oxygen saturation increased from 45 to 80, and satisfactory clinical improvement was observed in cyanotic group. Four patients required surgical interventions in acyanotic group, one for stent fracture and three for restenosis. Conclusion: Stent implantation in selected cases is a safe and effective alternative to surgery. Redilation or subsequent surgical interventions due to residual stenosis, somatic growth or neointimal proliferation may be required. In patients with cyanotic congenital heart disease who have a duct dependent pulmonary circulation with low chance of surgery use of coronary stents may be life-saving.
Anahtar Kelimeler
endovascular stent child transcatheter right sided cardiovascular
Kaynakça
- 1. Mullins CE, O’Laughlin MP, Vick GW, 3rd, Mayer DC, Myers TJ, Kearney DL et al. Implantation of balloon-expandable intravascular grafts by catheterization in pulmonary arteries and systemic veins. Circulation 1988;77:188-9.
- 2. O’Laughlin MP, Perry SB, Lock JE, Mullins CE. Use of endovascular stents in congenital heart disease. Circulation 1991;83:1923-39.
- 3. O’Laughlin MP, Slack MC, Grifka RG, Perry SB, Lock JE, Mullins CE. Implantation and intermediate-term follow-up of stents in congenital heart disease. Circulation 1993;88:605-14.
- 4. Ebeid MR, Prieto LR, Latson LA. Use of balloon-expandable stents for coarctation of the aorta: initial results and intermediate-term followup. J Am Coll Cardiol 1997;30:1847-52.
- 5. Redington AN, Hayes AM, Ho SY. Transcatheter stent implantation to treat aortic coarctation in infancy. Br Heart J 1993;69:80-2.
- 6. Ward CJ, Mullins CE, Nihill MR, Grifka RG, Vick GW, 3rd. Use of intravascular stents in systemic venous and systemic venous baffle obstructions. Short-term follow-up results. Circulation 1995;91:2948-54.
- 7. Hosking MC, Benson LN, Nakanishi T, Burrows PE, Williams WG, Freedom RM. Intravascular stent prosthesis for right ventricular outflow obstruction. J Am Coll Cardiol 1992;20:373-80.
- 8. Gibbs JL, Rothman MT, Rees MR, Parsons JM, Blackburn ME, Ruiz CE. Stenting of the arterial duct: a new approach to palliation for pulmonary atresia. Br Heart J 1992;67:240-5.
- 9. Ewert P, Schubert S, Peters B, Abdul-Khaliq H, Nagdyman N, Lange PE. The CP stent--short, long, covered--for the treatment of aortic coarctation, stenosis of pulmonary arteries and caval veins, and Fontan anastomosis in children and adults: an evaluation of 60 stents in 53 patients. Heart 2005;91:948-53.
- 10. Wilson N. Relief of right ventricular outflow tract obstruction. In: Percutaneous Interventions for Congenital Heart Disease. Sievert H, Qureshi SA, Wilson N, Hijazi ZM (eds), London, Informa Healthcare. 2007, pp.439-46.
- 11. Latson L. Pulmonary artery stenosis. In: Percutaneous Interventions for Congenital Heart Disease. Sievert H, Qureshi SA, Wilson N, Hijazi ZM (eds), London, Informa Healthcare. 2007, pp.447-56.
- 12. Rothman A, Perry SB, Keane JF, Lock JE. Early results and follow-up of balloon angioplasty for branch pulmonary artery stenoses. J Am Coll Cardiol 1990;15:1109-17.
- 13. Bush DM, Hoffman TM, Del Rosario J, Eiriksson H, Rome JJ. Frequency of restenosis after balloon pulmonary arterioplasty and its causes. Am J Cardiol 2000;86:1205-9.
- 14. Dohlen G, Chaturvedi RR, Benson LN, Ozawa A, Van Arsdell GS, Fruitman DS, et al. Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot. Heart 2009;95:142-7.
- 15. Dryzek P, Mazurek-Kula A, Moszura T, Sysa A. Right ventricle outflow tract stenting as a method of palliative treatment of severe tetralogy of Fallot. Cardiol J 2008;15:376-9.
- 16. Okubo M, Benson LN. Intravascular and intracardiac stents used in congenital heart disease. Curr Opin Cardiol 2001;16:84-91.
- 17. McMahon CJ, El-Said HG, Grifka RG, Fraley JK, Nihill MR, Mullins CE. Redilation of endovascular stents in congenital heart disease: factors implicated in the development of restenosis and neointimal proliferation. J Am Coll Cardiol 2001;38:521-6.
Öz
Amaç: Konjenital kalp hastalıklarında damar ve konduit darlıkları önemli bir sorundur. Merkezimizde sağ taraf kardiyovasküler yapılardaki darlıklara stent uygulanmış olan olguların klinik özellikleri ve sonuçları gözden geçirildi. Yöntemler: 1999-2010 yılları arasında merkezimizde sağ taraf kardiyovasküler yapılara 17 hastaya 18 stent implantasyonu yapıldı. Hastaların yaşı, geçirilmiş cerrahi öyküsü, darlık bölgesinin anatomisi, ölçülebilen hastalarda darlık distal ve proksimali arandaki basınç farkı belirlendi. Pulmoner arter dallarına, sağ ventrikül-pulmoner arter RV-PA arasına, Fontan konduitine ve sağ ventrikül çıkış yoluna balon ile genişletilebilir stent yerleştirilmiş olan hastalar çalışmaya dahil edildi. Klinik olarak siyanozu olmayan on üç hasta asiyanotik grup, siyanozu olan 4 hasta siyanotik grup olarak sınıflandırıldı. Bulgular: Olguların median yaşları 5 yıl 5 gün-17 yaş , vücut ağırlıkları 18 kg 3.2-65 kg idi. Asiyanotik grupta stent implantasyonu öncesi ve sonrası median sistolik basınç farkı mmHg RV-PA arasında 103’den 73’e; Fontan dolaşımında ve pulmoner arter dallarında 8 mmHg’dan 1 mmHg’ya düştü. Asiyanotik grupta darlık çapında 2.4 kat artış, siyanotik grupta oksijen saturasyonun median %45’den %80’e yükseldiği gözlendi, klinik olarak hastaların siyanozunda belirgin düzelme gözlendi. İzlem sırasında altı hastada stentte daralma görüldü. Asiyanotik grupta bulunan hastalardan dördüne stent implantasyonu sonrası cerrahi girişim yapıldı. Cerrahi girişim nedeni bir hastada stentte kırılma iken diğer hastalarda restenozdu. Sonuç: Konjenital veya edinsel darlıkları olan ve balon anjiyoplastiye yanıt alınamayan çocuklarda stent implantasyonu cerrahi tedaviye alternatif etkili ve güvenli bir yöntemdir. Somatik büyüme, neointimal proliferasyon ya da rezidüel darlık nedeniyle redilatasyon veya cerrahi girişim gerekebileceği akılda tutulmalıdır. Konjenital kalp hastalıklarında ağır hipoksi varlığında ve/veya cerrahi şansının düşük olduğu durumlarda darlık bölgesine koroner stent uygulaması hayat kurtarıcı olabilir.
Anahtar Kelimeler
endovasküler stent çocuk transkateter sağ taraf kardiyovasküler
Kaynakça
- 1. Mullins CE, O’Laughlin MP, Vick GW, 3rd, Mayer DC, Myers TJ, Kearney DL et al. Implantation of balloon-expandable intravascular grafts by catheterization in pulmonary arteries and systemic veins. Circulation 1988;77:188-9.
- 2. O’Laughlin MP, Perry SB, Lock JE, Mullins CE. Use of endovascular stents in congenital heart disease. Circulation 1991;83:1923-39.
- 3. O’Laughlin MP, Slack MC, Grifka RG, Perry SB, Lock JE, Mullins CE. Implantation and intermediate-term follow-up of stents in congenital heart disease. Circulation 1993;88:605-14.
- 4. Ebeid MR, Prieto LR, Latson LA. Use of balloon-expandable stents for coarctation of the aorta: initial results and intermediate-term followup. J Am Coll Cardiol 1997;30:1847-52.
- 5. Redington AN, Hayes AM, Ho SY. Transcatheter stent implantation to treat aortic coarctation in infancy. Br Heart J 1993;69:80-2.
- 6. Ward CJ, Mullins CE, Nihill MR, Grifka RG, Vick GW, 3rd. Use of intravascular stents in systemic venous and systemic venous baffle obstructions. Short-term follow-up results. Circulation 1995;91:2948-54.
- 7. Hosking MC, Benson LN, Nakanishi T, Burrows PE, Williams WG, Freedom RM. Intravascular stent prosthesis for right ventricular outflow obstruction. J Am Coll Cardiol 1992;20:373-80.
- 8. Gibbs JL, Rothman MT, Rees MR, Parsons JM, Blackburn ME, Ruiz CE. Stenting of the arterial duct: a new approach to palliation for pulmonary atresia. Br Heart J 1992;67:240-5.
- 9. Ewert P, Schubert S, Peters B, Abdul-Khaliq H, Nagdyman N, Lange PE. The CP stent--short, long, covered--for the treatment of aortic coarctation, stenosis of pulmonary arteries and caval veins, and Fontan anastomosis in children and adults: an evaluation of 60 stents in 53 patients. Heart 2005;91:948-53.
- 10. Wilson N. Relief of right ventricular outflow tract obstruction. In: Percutaneous Interventions for Congenital Heart Disease. Sievert H, Qureshi SA, Wilson N, Hijazi ZM (eds), London, Informa Healthcare. 2007, pp.439-46.
- 11. Latson L. Pulmonary artery stenosis. In: Percutaneous Interventions for Congenital Heart Disease. Sievert H, Qureshi SA, Wilson N, Hijazi ZM (eds), London, Informa Healthcare. 2007, pp.447-56.
- 12. Rothman A, Perry SB, Keane JF, Lock JE. Early results and follow-up of balloon angioplasty for branch pulmonary artery stenoses. J Am Coll Cardiol 1990;15:1109-17.
- 13. Bush DM, Hoffman TM, Del Rosario J, Eiriksson H, Rome JJ. Frequency of restenosis after balloon pulmonary arterioplasty and its causes. Am J Cardiol 2000;86:1205-9.
- 14. Dohlen G, Chaturvedi RR, Benson LN, Ozawa A, Van Arsdell GS, Fruitman DS, et al. Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot. Heart 2009;95:142-7.
- 15. Dryzek P, Mazurek-Kula A, Moszura T, Sysa A. Right ventricle outflow tract stenting as a method of palliative treatment of severe tetralogy of Fallot. Cardiol J 2008;15:376-9.
- 16. Okubo M, Benson LN. Intravascular and intracardiac stents used in congenital heart disease. Curr Opin Cardiol 2001;16:84-91.
- 17. McMahon CJ, El-Said HG, Grifka RG, Fraley JK, Nihill MR, Mullins CE. Redilation of endovascular stents in congenital heart disease: factors implicated in the development of restenosis and neointimal proliferation. J Am Coll Cardiol 2001;38:521-6.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2014 |
| Yayımlandığı Sayı | Yıl 2014Sayı: 2 |