Abstract
Obstruction develops commonly at the acute-angled portion of the vessels following palliative surgery, such as systemic–pulmonary shunt (SP shunt), right ventricle–to–pulmonary artery shunt (RV–PA shunt) in the Norwood–Sano procedure for hypoplastic left heart syndrome, and cavopulmonary (Glenn) anastomosis. Although balloon angioplasty is a treatment option, dilation with existing straight balloons is sometimes ineffective and technically complicated because of balloon slippage and target vessel distortion. In this study, we investigated the effectiveness of a curved GOKU balloon catheter for balloon angioplasty in postoperative acute-angled lesions associated with palliative surgery for congenital heart disease. We reviewed patients who underwent balloon angioplasty for angled lesions complicated by SP shunt, RV–PA shunt, or Glenn anastomosis, using the novel curved GOKU or a conventional balloon catheter, such as a Sterling balloon catheter. We evaluated patients’ backgrounds, balloon specifications, target lesion anatomical features and angles, and short-term outcomes. We evaluated 45 procedures in 18 patients. A curved GOKU was used in 20 procedures, and a Sterling balloon in 25 procedures. The angulation of the lesions at maximum balloon inflation was significantly smaller using a curved GOKU vs a Sterling balloon [70–120 (mean ± standard deviation, 97 ± 40) degrees vs 110–180 (149 ± 46) degrees, respectively; p < 0.001], while the original angle was similar between the groups. Patients’ short-term outcomes with the curved GOKU were excellent, with a significantly better percent increase in minimum lumen diameter of 0–220% (92% ± 66%) vs 0–46% (18% ± 15%) with the Sterling balloon (p < 00.1) and with less frequent balloon slippage. The curved GOKU was more effective in balloon angioplasty for acute-angled lesions compared with a conventional straight balloon, likely because of better conformability to the lesion angle and slip resistance.
Highlights
Obstruction develops commonly at the acute-angled portion of the vessels following palliative surgery, such as systemic–pulmonary shunt (SP shunt) [1,2,3], right ventricle–to–pulmonary artery shunt (RV–PA shunt) in the Norwood–Sano procedure for hypoplastic left heart syndrome [4,5,6,7], and cavopulmonary (Glenn) anastomosis [8, 9].Catheter intervention is an effective treatment option for these lesions; balloon angioplasty using existing straight balloons is sometimes ineffective and technically complicated [10, 11]
A curved GOKU was used in 20 procedures, and a Sterling balloon was used in 25 procedures
In seven patients who underwent balloon angioplasty using a Sterling balloon, because significant balloon slippage occurred in five patients, and inadequate dilation owing to balloon kinking occurred in two patients, we replaced the Sterling balloons with a curved GOKU in the same session
Summary
Obstruction develops commonly at the acute-angled portion of the vessels following palliative surgery, such as systemic–pulmonary shunt (SP shunt) [1,2,3], right ventricle–to–pulmonary artery shunt (RV–PA shunt) in the Norwood–Sano procedure for hypoplastic left heart syndrome [4,5,6,7], and cavopulmonary (Glenn) anastomosis [8, 9].Catheter intervention is an effective treatment option for these lesions; balloon angioplasty using existing straight balloons is sometimes ineffective and technically complicated [10, 11]. The technical failure of balloon angioplasty for such lesions is partially caused by balloon slippage and target vessel distortion. Acute angulation at the proximal and/or distal anastomosis may cause excessive stress on the vessel wall adjacent to the stenosis during the procedure. The curved GOKU balloon catheter (Tokai Medical Products, Aichi, Japan) is specially designed for acute-angled lesions and bends to approximately 90° when maximally inflated (Fig. 1). This is a noncompliant balloon made of polyamide elastomer with a low profile that can pass through a 4-Fr sheath, and that can accept a 0.018-inch guidewire.
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