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Balloon dilatation angioplasty of stenosed systemic-pulmonary artery shunts
I L Saltik1, A G Eroğlu, F Oztunç
1Department of Pediatric Cardiology, Istanbul University, Turkey.
Insights
Balloon dilatation angioplasty (BDA) effectively improved oxygen saturation in patients with congenital heart defects. The transvenous route is a safe and effective method, especially for low-weight children.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Cyanotic congenital heart defects often necessitate surgical shunts to improve pulmonary blood flow.
- Stenosis of systemic-pulmonary artery shunts can compromise arterial oxygen saturation.
- Balloon dilatation angioplasty (BDA) is an alternative to surgical revision for shunt stenosis.
Purpose of the Study:
- To evaluate the efficacy and safety of BDA for stenosed systemic-pulmonary artery shunts in patients with cyanotic congenital heart defects.
- To assess the feasibility of using a transvenous approach for BDA, particularly in low-weight children.
- To determine the impact of BDA on arterial oxygen saturation and long-term clinical outcomes.
Main Methods:
- Retrospective analysis of eight patients (seven children, one adult) with cyanotic congenital heart defects and stenosed systemic-pulmonary artery shunts.
- Attempted transvenous BDA in patients with right ventricle-to-aorta connection (e.g., Tetralogy of Fallot, Double Outlet Right Ventricle) to avoid femoral artery injury.
- Successful transvenous BDA was performed in four pediatric patients, including one weighing 6.6 kg.
Main Results:
- Post-BDA, mean arterial oxygen saturation increased significantly from 65.9% to 78.1% (p < 0.05).
- All patients showed clinical improvement during 3-37 months of follow-up.
- One patient developed pulmonary hypertension during follow-up.
Conclusions:
- BDA of stenosed systemic-pulmonary artery shunts is a reasonable, effective, and safe therapeutic option.
- The transvenous route, when feasible, offers a safe method for advancing larger balloons in low-weight pediatric patients.
- BDA provides a valuable minimally invasive strategy for managing shunt-related hypoxemia in congenital heart disease.
Abstract:
Seven children and an adult patient with cyanotic congenital heart defects underwent balloon dilatation angioplasty (BDA) of a stenosed systemic-pulmonary artery shunt to improve arterial oxygen saturation. We attempted to perform BDA using the transvenous route in all patients in whom the aorta connected with the right ventricle, such as in tetralogy of Fallot or double outlet right ventricle, in an effort to avoid femoral artery injury. We could use the transvenous route (antegrade) in three children with tetralogy of Fallot and in one child with tetralogy of Fallot and pulmonary atresia (one of them was 6.6 kg). Following BDA, there was an increase in arterial oxygen saturation from a mean of 65.9 +/- 12.8% to a mean of 78.1 +/- 8.3% (p < 0.05). On follow-up three to 37 months (mean 16.5 +/- 11.2 months) after BDA, the condition of all patients had improved. Pulmonary hypertension developed in one patient during the follow-up period. It is concluded that BDA of stenosed systemic-pulmonary artery shunts is reasonable, effective and safe. Use of the transvenous route, if possible, to perform balloon dilatation angioplasty facilitates the safe advancement of the larger balloons in low-weight children.