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Published on: July 18, 2014
Intravascular lithotripsy-assisted intervention in patients with congenital heart disease
Zachary L Steinberg1, Lauren N Carlozzi2, Brian H Morray3
1Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington.
Insights
Intravascular lithotripsy (IVL) is a novel treatment for calcified congenital heart disease. This study shows IVL is feasible for complex procedures like stenting and valve replacement, offering a new option for these patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Intravascular lithotripsy (IVL) is widely used for calcified coronary and peripheral artery disease.
- Its application in congenital heart disease (CHD) procedures is limited, with scarce published data.
- This study explores IVL's role in complex CHD interventions.
Purpose of the Study:
- To report the outcomes of four patients with CHD who underwent IVL-assisted transcatheter procedures.
- To inform future operators about the potential benefits and risks of IVL in this specific patient population.
Main Methods:
- Four patients with CHD underwent IVL-assisted transcatheter interventions.
- Procedures included branch pulmonary artery stenting, aortic coarctation stenting, and transcatheter pulmonary valve replacement.
- IVL was used to facilitate the implantation of large stents in highly calcified native or surgically implanted biological conduits.
Main Results:
- All four patients successfully received IVL-assisted stent implantation.
- Procedures involved highly calcified native or surgically implanted biological conduits.
- No significant complications were reported during the IVL-assisted procedures.
Conclusions:
- IVL-assisted interventions are feasible for patients with severe calcified vascular conduits in CHD.
- IVL may serve as a valuable adjunct for conduit stent implantation and dilation.
- Vascular injury remains a risk; covered stent implantation is recommended before aggressive dilation to prevent rupture.
Objectives:
The use of intravascular lithotripsy (IVL) in patients with calcified coronary and peripheral arterial disease is now commonplace; however, its use in procedures specific to congenital heart disease is rare, with a very limited published case-based experience to date. The authors report the outcomes of 4 patients with congenital heart disease who underwent IVL-assisted transcatheter procedures in the effort to inform future operators as to the potential benefits and risks of this technology in this patient population.
Methods And Results:
Four patients underwent IVL-assisted transcatheter procedures including branch pulmonary artery stenting, aortic coarctation stenting, and transcatheter pulmonary valve replacement. All 4 patients underwent successful IVL-assisted implantation of large stents in highly calcified native or surgically implanted biological conduits without significant complications.
Conclusions:
The use of IVL-assisted interventions in patients with severe native or surgical calcified vascular conduits is feasible and may be a useful adjunct in conduit stent implantation and dilation. Vascular injury during angioplasty of calcified vessels and conduits remains a concern despite the use of lithotripsy, and covered stent implantation should be considered prior to aggressive dilation in order to reduce the risk of catastrophic rupture.
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