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Complete fracture of a right ventricle to pulmonary artery shunt
  1. S J Murugan,
  2. D F Dickinson,
  3. J L Gibbs

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A 3 week old baby boy with type 1 truncus arteriosus had reconstruction of the right ventricular outflow tract with a 12 mm aortic homograft. He developed early conduit stenosis, and a 16 mm aortic homograft was implanted at the age of 30 months. Within 12 months, he again developed severe conduit stenosis. A 27 mm genesis (J+J) diameter was implanted at the right ventricular outflow tract with a good angiographic result and a fall in right ventricular pressure from 104 mm Hg to 70 mm Hg. Eight months later, the obstruction had recurred. Fluoroscopy showed complete circumferential fracture of the stent.

Right ventricle to pulmonary artery homografts and biosynthetic conduits frequently develop progressive obstruction. The principal benefit of balloon expandable intravascular stents lies in prolonging conduit life span and decreasing the number of conduit reoperations. Fracture of the stents is a recognised adverse effect, usually identified as an incidental finding on chest x ray, echocardiogram, or fluoroscopy. The main predisposing factor could be caused by external compression between the sternum and aorta. Uneven stresses on stents, wherein the proximal part lies within the right ventricular wall, could also predispose to fracture because of the effect of myocardial compression.

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