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Percutaneous Pulmonary Flow Restriction in Infants With Congenital Heart Disease
Matthew Warren1, Ana Vasquez Choy1, Mohammed Khan1
1Children's Heart Institute, Children's Memorial Hermann Hospital, UTHealth, Houston, Texas, USA.
Insights
This study shows that percutaneous pulmonary blood flow (PBF) restriction is a safe, less invasive method for infants with congenital heart disease (CHD). It effectively controls PBF, allowing time for growth before surgery and reducing sternotomies.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Pulmonary blood flow (PBF) restriction is crucial in infants with congenital heart disease (CHD) to prevent pulmonary over-circulation before definitive treatment.
- Current surgical pulmonary artery banding has limitations and complications.
Purpose of the Study:
- To evaluate a novel percutaneous technique for restricting PBF in select infants with CHD.
- To assess the safety and efficacy of this less invasive approach.
Main Methods:
- Modified vascular plug devices were percutaneously placed in bilateral branch pulmonary arteries.
- Patients selected had CHD requiring PBF control due to low birth weight or prematurity.
Main Results:
- Seven neonates with CHD underwent the procedure, demonstrating restricted PBF and decreased oxygen saturation (95% to 84%).
- Five patients showed adequate PBF limitation on presurgical cardiac catheterization (mean PVR 1.52 WU×m², mTPG 5.9 mm Hg).
- All patients proceeded to surgical intervention without major complications like device embolization.
Conclusions:
- Percutaneous PBF restriction is a safe, less invasive alternative to surgical banding.
- This technique facilitates somatic growth and gestational maturation by delaying surgical intervention.
- It potentially reduces the number of sternotomies required for CHD treatment.
Background:
Restriction of PBF in infants born with CHD is often required to avoid pulmonary over-circulation prior to definitive intervention. The current standard is to surgically place pulmonary artery bands, but these have limitations and are associated with complications.
Objectives:
The purpose of this study was to a single-center experience with a relatively novel technique to percutaneously restrict pulmonary blood flow (PBF) in select infants with congenital heart disease (CHD).
Methods:
Patients were selected to undergo this procedure either due to low birth weight or prematurity. All of them had CHD that would result in over-circulation without control of PBF. By a percutaneous method, modified vascular plug devices were placed in the bilateral branch pulmonary arteries.
Results:
Seven neonates with CHD resulting in left-sided obstruction underwent this procedure. All patients demonstrated evidence of restricted PBF with a decrease in mean oxygen saturation from 95% to 84%. One patient required pulmonary artery band placement due to over-circulation 5 days after the procedure. All patients proceeded to full surgical intervention without device embolization or need for pulmonary arterioplasty. Hemodynamics demonstrated adequate limitation of PBF in 5 patients who underwent presurgical cardiac catheterization with a mean pulmonary vascular resistance of 1.52 WU × m2 and a mean transpulmonary gradient of 5.9 mm Hg.
Conclusions:
Percutaneous PBF restriction appears to be safe and a less invasive option to delay surgical intervention in a select population to allow for somatic growth and gestational maturation. It results in a decrease in the total number of sternotomies.
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