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Transluminally placed endovascular grafts to exclude undesirable intracardiac vascular communications
1Radiology Associates, P.C., P.O. Box 482, Eugene, OR 97440, USA. squinn@peacehealth.org
Insights
Transluminally placed endovascular grafts (TPEG) show promise for closing intracardiac communications in patients with surgically corrected congenital heart disease. This early experience demonstrates improved oxygen saturation and exercise tolerance with no device complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Surgically corrected congenital heart disease can lead to intracardiac communications and hypoxemia.
- Intracardiac shunts may arise from fenestrations, anastomotic leaks, or baffle perforations.
- Transluminally placed endovascular grafts (TPEG) offer a potential percutaneous solution.
Purpose of the Study:
- To evaluate the early experience of using TPEG devices to close intracardiac communications.
- To assess the safety and efficacy of TPEG in patients with surgically corrected congenital heart disease.
Main Methods:
- Three patients with surgically corrected congenital heart disease (Modified Fontan or Mustard procedure) and intracardiac shunts were treated.
- Percutaneous venous-side approaches were used to deploy TPEG devices.
- TPEG devices consisted of pre-expanded polytetrafluoroethylene (PTFE) on a Palmaz stent.
Main Results:
- Complete exclusion of leaks was achieved in two patients with Modified Fontan procedures.
- All patients experienced significant and sustained improvements in oxygen saturation (mean, 17.3% at follow-up).
- No TPEG-related complications such as stenosis, occlusion, or migration were observed during follow-up (mean, 15 months).
Conclusions:
- TPEG devices are a viable option for excluding intracardiac communications in complex congenital heart disease.
- Preliminary results are encouraging, supporting further investigation of TPEG for these indications.
- The procedure demonstrated improved clinical outcomes, including exercise tolerance and weight gain, without complications.
Purpose:
In this report, we summarize our early experience using transluminally placed endovascular grafts (TPEG) to close intracardiac communications within surgically created conduits.
Materials And Methods:
Three patients with surgically corrected congenital heart disease were treated in this study. All three patients had intracardiac conduits [Modified Fontan (n = 2) or Mustard procedure (n = 1)]. All three patients had intracardiac shunts causing hypoxemia. The shunts were caused by a surgically created fenestration (n =1), a leak at a surgical anastomosis (n = 1) and perforations of a pericardial baffle (n = 1). All three patients were treated percutaneously from venous side approaches. The TPEG devices were constructed of pre-expanded polytetrafluoroethylene (PTFE) sutured to a Palmaz stent.
Results:
In the two patients with the modified Fontan procedures, the leaks were completely excluded; in the patient with the Mustard procedure, the perforations in the baffle were not completely excluded. All patients experienced immediate improvements in oxygen saturation ranging from 17Eth 26% (mean, 20.3%). The improvements in oxygen saturation were sustained with values ranging from 12Eth 22% (mean, 17.3%) at the time of clinical follow-up. Clinical follow-up has ranged from 13Eth 19 months (mean, 15 months) and has demonstrated improved exercise tolerance and weight gain. Echocardiographic follow-up has shown no complications of TPEG stenoses, occlusions or migrations. There were no immediate or delayed complications associated with the TPEG devices.
Conclusion:
We report our experience using TPEG devices to exclude intracardiac communications in 3 patients with surgically corrected congenital heart disease. The preliminary results are encouraging and suggest that further investigation in this area should be done.
