Heart 1998;79:230-233 ( March )
Self expandable stents for relief of venous baffle obstruction after the Mustard operation
a Paediatric Cardiology, University Hospital
Gasthuisberg, Leuven, Belgium, b Radiology
Correspondence to: Professor Dr M Gewillig, Paediatric Cardiology, University Hospitals Leuven, B 3000, Leuven, Belgium.
Accepted for publication 15 July 1997
Objective
Obstruction of the venous pathways after
Mustard repair for transposition of the great arteries is associated
with an increased risk of arrhythmia and sudden death. The purpose of
this study was to assess the effectiveness of the largest (tracheal
22 × 40 mm) Wallstents in treating baffle obstructions.
DesignRetrospective analysis of patients
with stented venous pathways.
SubjectsEleven patients with baffle obstruction
after Mustard repair for transposition of the great arteries.
InterventionsStenoses were dilated with an 18 or
20 mm balloon. However, recoil was noticed in 11 patients: immediately
(n = 7) or on repeat angiography (n = 4). Eighteen stents were
implanted (mean (SD)) 18 (3.3) years postoperatively. After dilatation
a tracheal Wallstent (11.5 F) was deployed.
Main outcome measuresRelief of obstruction,
haemodynamic improvement.
ResultsIn the inferior vena cava, 10 stents
were deployed in seven baffle obstructions with an increase in diameter
from 9.8 (2.4) mm to 16.5 (1.4) mm (p < 0.01) and a mean (SD)
pressure gradient decrease from 5.1 (3.6) mm Hg to
1.4 (2.0) mm Hg; in the superior vena cava, eight stents were
implanted increasing the diameter from 9.1 (3.7) mm to
15.6 (3.8) mm (p < 0.001) with a decrease in mean pressure
gradient from 5.1 (2.7) mm Hg to 1.9 (1.5) mm Hg. No
complications were experienced during implantation. No anticoagulation
was prescribed. During follow up (1.7 (0.6) years; range, 0.9-2.6) no
problems were noted; five patients were re-catheterised without change
in measurements. There was no evidence of peal formation in any of the stents.
ConclusionIt is concluded that Wallstents are
safe, easy to use, and effective in relieving baffle obstruction.
Anticoagulation does not seem neccessary.
© 1998 by Heart
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[Abstract] [Full Text] -
ROSENTHAL, E, QURESHI, S A
(1998). Stenting of systemic venous pathways after atrial repair for complete transposition. Heart
79: 211-212
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