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Published on: February 11, 2017
Growable Shunt as Novel Therapy in Children Requiring Aortopulmonary Shunt for Extended Time
Alexander P Bruno1, Daniel K Ragheb1, Dana R Janssen2
1Vanderbilt University School of Medicine, Nashville, Tennessee.
Insights
A novel stent-restricted aortopulmonary shunt offers a safe, expandable solution for complex congenital heart defects, potentially avoiding repeat surgeries in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Biomedical Engineering
Background:
- Complex congenital heart defects (CHDs) often require palliative surgical interventions.
- Double-inlet left ventricle presents significant surgical challenges.
- Aortopulmonary shunts are crucial for palliation but can face occlusion or growth limitations.
Observation:
- A 35-month-old girl with double-inlet left ventricle and an occluded ductal stent presented for surgical management.
- Pulmonary artery unifocalization and central shunt placement were performed.
- A novel stent-restricted aortopulmonary shunt was utilized anticipating prolonged shunt function.
Findings:
- The stent-restricted shunt was designed to accommodate somatic growth, extending shunt longevity.
- This technique allowed for shunt dilation without requiring repeat open surgical procedures.
- The novel approach demonstrated safety and feasibility in a pediatric patient with complex CHD.
Implications:
- This expandable shunt technique may reduce the need for reoperations in pediatric CHD patients.
- It offers a promising strategy for managing aortopulmonary shunts in growing children.
- This innovation could improve long-term outcomes for patients with complex single-ventricle physiology.
Abstract:
We describe a 35-month-old girl with a complex congenital heart defect including double-inlet left ventricle who presented with an occluded ductal stent. We performed pulmonary artery unifocalization and central shunt placement to bridge to Fontan or as final palliation. Anticipating a prolonged role for the shunt, we used a novel approach to aortopulmonary shunt construction consisting of a stent-restricted shunt that allows extended shunt longevity through an ability to "grow" with the patient's somatic growth. This technique demonstrates a safe way to dilate aortopulmonary shunts without repeated open surgical intervention.
