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Sustained high pressure double balloon angioplasty of calcified conduits
N Sreeram1, P Hutter, E Silove
1Department of Cardiology, Wilhelmina Children's Hospital, ABC Straat, 3501 CA Utrecht, The Netherlands.
Insights
Prolonged high-pressure angioplasty effectively dilated calcified cardiac conduits in children, reducing pressure gradients and improving clinical outcomes. This technique may extend time between conduit replacements for complex heart defects.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Calcified and stenotic cardiac conduits pose significant challenges in pediatric patients.
- Conduit stenosis often necessitates reintervention or surgical replacement, impacting long-term outcomes.
- Effective management strategies are crucial for improving the quality of life in children with complex heart defects.
Purpose of the Study:
- To evaluate the efficacy of prolonged high-pressure angioplasty for dilating calcified and stenotic cardiac conduits in pediatric patients.
- To assess the impact of this intervention on hemodynamic parameters and clinical status.
- To determine the potential of this technique in delaying subsequent interventions.
Main Methods:
- A prospective study involving six calcified and stenotic cardiac conduits in five pediatric patients (age 4-17 years).
- Sustained high-pressure (up to 18 atm) double balloon angioplasty (up to 5 minutes) was performed.
- Included right ventricle to pulmonary artery (RV-PA) conduits and venous conduits in Fontan circulation.
Main Results:
- Significant reduction in RV-PA gradients (median 48 to 11 mm Hg) and RV-femoral pressure ratios (median 0.8 to 0.4).
- All five patients experienced sustained clinical improvement at a median 12-month follow-up.
- No patient required reintervention or surgery post-procedure.
Conclusions:
- Prolonged high-pressure double balloon angioplasty is effective in managing calcified and stenotic pediatric cardiac conduits.
- This interventional approach can lead to significant hemodynamic improvement and sustained clinical benefit.
- The technique shows promise in extending the interval between conduit replacements in select pediatric patients with complex congenital heart disease.
Objective:
To assess the efficacy of prolonged high pressure angioplasty for dilatation of calcified and stenotic cardiac conduits in children.
Design:
A prospective study of consecutive patients presenting with calcified and stenotic conduits.
Setting:
Two tertiary paediatric cardiology departments.
Methods:
Sustained (up to five minutes), high pressure (up to 18 atmospheres), double balloon angioplasty was performed in six calcified and stenotic cardiac conduits (five consecutive patients, three male, two female, age 4 to 17 years). Four patients had right ventricle to pulmonary artery (RV-PA) conduits, and one had two venous conduits in a Fontan circulation.
Results:
Marked reductions in right ventricle to pulmonary artery gradients, from a median (range) of 48 (40 to 62) mm Hg to 11 (5 to 16) mm Hg, and in right ventricle to femoral artery pressure ratios, from a median of 0.8 (0.72 to 0.86) to 0.4 (0.33 to 0.44), were achieved for all RV-PA conduits. All five patients had sustained clinical improvement at follow up (median follow up 12 months) and none has required reintervention or surgery.
Conclusions:
Prolonged high pressure double balloon angioplasty may have a role in prolonging the interval between conduit replacements in a subset of patients with complex heart defects.