Stenting of the right ventricular outflow tract

• Published in: Heart (British Cardiac Society) Vol. 99; no. 21; pp. 1603 - 1608
• Main Authors: Stumper, Oliver, Ramchandani, Bharat, Noonan, Patrick, Mehta, Chetan, Bhole, Vinay, Reinhardt, Zdenka, Dhillon, Rami, Miller, Paul A, de Giovanni, Joseph V
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.11.2013; BMJ Publishing Group LTD
• Subjects: Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Catheters; Child, Preschool; Coronary Angiography; Female; Humans; Infant; Infant, Newborn; Male; Multidisciplinary teams; Ostomy; Pulmonary arteries; Pulmonary Circulation; Recovery of Function; Retrospective Studies; Stents; Time Factors; Treatment Outcome; Veins & arteries; Ventricular Outflow Obstruction - diagnosis; Ventricular Outflow Obstruction - mortality; Ventricular Outflow Obstruction - physiopathology; Ventricular Outflow Obstruction - therapy; Florida; United States > US; Europe
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2013-304155

Objective To assess the indication, technical aspects, and outcome of stenting of the right ventricular outflow tract (RVOT) in the management of symptomatic patients with severely limited pulmonary blood flow. Methods Retrospective case note and procedure review of patients undergoing stenting of the RVOT over an 8 year period. Patients Between 2005 and 2012, 52 selected patients underwent percutaneous stent implantation into a very narrow RVOT to improve pulmonary blood flow. Median age at stent implantation was 63 (range 4–406) days and median weight was 3.8 (1.7–12.2) kg. Results 52 patients underwent stent implantation. Median procedure time was 57 (24–260) min and fluoroscopy time 16 (5.5–73) min. There was one procedural death (1.9%) and one emergency surgery (1.9%). Saturations increased from 71% (52–83%) to 92% (81–100%) (p<0.001). Two patients required early shunts due to inadequate palliation and two died from non-cardiac causes. Sixteen further catheter interventions were undertaken (balloon in 7, further stent in 9). Twenty-nine patients underwent delayed surgery (complete repair in 26, palliative in 3) at a median of 172 (52–758) days post-stenting. Left pulmonary artery Z score increased from a pre-interventional value of −1.75 (−4.96 to 0.67) to a pre-surgical value of −0.55 (−4.12 to 1.97), (p<0.01). Median right pulmonary artery Z score increased from −2.63 (−7.70 to 0.89) to −0.75 (−6.69 to 1.18) (p<0.01) . Seventeen patients remain well palliated after a median of 122 (40–286) days. Conclusions Stenting of the RVOT is an effective treatment option in the initial management of selected patients with very reduced pulmonary blood flow.