Heart 1998;79:225-229 ( March )
Balloon expandable stents for systemic venous pathway stenosis late after Mustard's operation
Heart Clinic, Royal
Liverpool Children's Hospital, Alder Hey, Eaton Road,
Liverpool L12 2AP, UK
Correspondence to: Dr Bu'Lock.
Accepted for publication 3 October 1997
Objectives
Description and evaluation of current
experience with the use of balloon expandable stents for the relief of
systemic venous pathway stenosis late after Mustard's operation.
DesignRetrospective observational study of
technical procedures, angiographic, and haemodynamic findings.
PatientsTwenty long term survivors of Mustard's
operation for transposition of the great arteries (TGA) with
angiographic evidence of systemic venous pathway narrowing.
InterventionSystemic venous pathway stenoses were
stented using balloon expandable Palmaz stents.
ResultsTwenty seven stents were deployed across
24 stenoses. Seventeen stents were placed in the inferior baffle (16 patients), with an increase in mean (range) minimum diameter from 9.6 (4.5-15.9) to 16.5 (11.9-22.2) mm (p = 0.007), and a reduction in
mean pressure gradient from 3.1 (0-8) to 0.67 (0-3) mm Hg
(p = 0.002). Eight stents were placed in the superior pathways of
eight patients, with diameters widened from 9.1 (3.5-14.1) to 15.2 (8.7-19.2) mm (p = 0.018), and gradients reduced from 6.4 (2-11)
to 0.9 (0-2) mm Hg (p = 0.02). Two badly deployed stents were
safely withdrawn from their intracardiac positions and redeployed in
the iliac vein. Transvenous pacemaker insertion was facilitated by
prior stent insertion.
ConclusionsThe use of balloon expandable stents
for late systemic pathway narrowing after Mustard's operation is safe
and effective. The beneficial effects of stenting are likely to be more
durable than those of balloon angioplasty alone, but longer term follow up is required.
© 1998 by Heart
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