Pulmonary Coarctation Research Articles

Favourable Short- to Mid-Term Outcome after PDA-Stenting in Duct-Dependent Pulmonary Circulation.

Background. Stenting of patent ductus arteriosus (PDA) is a minimally invasive catheter-based temporary palliative procedure that is an alternative to a surgical shunt in neonates with duct-dependent pulmonary perfusion. Methods. An observational, single-centre, cross-sectional study of patients with duct-dependent pulmonary perfusion undergoing PDA-stenting as a stage I procedure and an analysis of short- to mid-term follow-up until a subsequent surgical procedure (stage II), with a focus on the interstage course. Results. Twenty-six patients were treated with PDA-stenting at a median (IQR) age of 7 (4–10) days; 10/26 patients (38.5%) (6/10 single pulmonary perfusion) were intended for later univentricular palliation, 16/26 patients (61.5%) (13/16 single pulmonary perfusion) for biventricular repair. PDA diameter was 2.7 (1.8–3.2) mm, stent diameter 3.5 (3.5–4.0) mm. Immediate procedural success was 88.5%. The procedure was aborted, switching to immediate surgery after stent embolisation, malposition or pulmonary coarctation in three patients (each n = 1). During mid-term follow-up, one patient needed an additional surgical shunt due to severe cyanosis, while five patients underwent successful catheter re-intervention 27 (17–30) days after PDA-stenting due to pulmonary hypo- (n = 4) or hyperperfusion (n = 1). Interstage mortality was 8.6% (2/23), both in-hospital and non-procedure-related. LPA grew significantly (p = 0.06) between PDA-stenting and last follow-up prior to subsequent surgical procedure (p = 0.06). RPA Z-scores remained similar (p = 0.22). The subsequent surgical procedure was performed at a median age of 106 (76.5–125) days. Conclusions. PDA-stenting is a feasible, safe treatment option, with the need for interdisciplinary decision-making beforehand and surgical backup afterwards. It allows adequate body and pulmonary vessel growth for subsequent surgical procedures. Factors determining the individual patient’s course should be identified in larger prospective studies.

Primary central pulmonary artery plasty for right atrial isomerism with pulmonary coarctation.

Patients with unbalanced pulmonary artery growth resulting from pulmonary coarctation are considered unsuitable candidates for the Fontan procedure. Particularly, patients with right isomerism pose a challenge. We aimed to investigate the use of primary central pulmonary artery plasty at initial palliation in patients with right isomerism. We recruited 34 right isomerism patients with pulmonary atresia and pulmonary coarctation who underwent modified Blalock-Taussig shunt with or without primary central pulmonary artery plasty between 1998 and 2014. We classified them into the primary central pulmonary artery plasty (group P) and no primary central pulmonary artery plasty (group N) groups. We retrospectively analyzed reintervention for pulmonary artery after initial palliation, difference in size between the left and right pulmonary arteries, overall survival, success of the Fontan procedure. The group P and group N included 25 and 9 patients, respectively. Five (20%) and six (67%) patients in group P and group N, respectively, required reintervention for pulmonary artery after initial palliation (p = 0.017). No patient underwent reintervention for the pulmonary artery before bidirectional cavopulmonary shunt in group P. There was a significant difference in the bilateral pulmonary artery size balance between the groups before bidirectional cavopulmonary shunt (p = 0.041). The two-lung Fontan procedure was successful in 14 (56%) and 1 (11%) patient in group P and group N. Primary central pulmonary artery plasty may contribute toward improving the balance in the size of the PA and preclude the need for reintervention for PA.

Primary Central Pulmonary Artery Plasty for Ductal-Associated Pulmonary Artery Coarctation

Infants with functionally single ventricle who require a modified Blalock-Taussig shunt can have stenosis at the ductal insertion site on the pulmonary artery (PA), the so-called ductal-associated PA coarctation. We hypothesized that central PA plasty with resection of the ductal tissue on the PA during the first palliation would prevent PA coarctation and obtain well-balanced PA for Fontan operation. We performed this strategy on 40 consecutive patients (from 1998 to 2012, Age 38.4 ± 24.7 day [17 neonates], body weight 3.5 ± 0.8 kg, heterotaxy n = 27). The mean Nakata index (mm2/m2) before bidirectional cavopulmonary shunt was 230.7 ± 101.7 without pulmonary stenosis. The PA diameter ratio and lung perfusion ratio (nonshunt side and/or shunt side) were 0.93 ± 0.25 and 0.9 ± 0.2, respectively. This strategy may improve clinical outcomes on functional single ventricle patients with increased risk of stenosis from pulmonary coarctation, with avoidance of an unbalanced pulmonary vascular bed.

Pulmonary Arterial Reconstruction for Pulmonary Coarctation in Early Infancy

Pulmonary atresia with pulmonary coarctation may complicate diminished and unbalanced pulmonary development. The aim of this study is to assess the outcome of pulmonary arterial reconstruction with cardiopulmonary bypass in early infancy for sufficient and balanced pulmonary development. We performed a retrospective review of 15 patients with pulmonary coarctation younger than 4 months of age who underwent pulmonary arterial reconstruction between 2001 and 2005. The mean age and weight were 42.2 days and 3.62 kg, respectively. The patient population included 5 biventricular repair candidates and 10 Fontan candidates. To evaluate the pulmonary arterial development, the preoperative and postoperative pulmonary arterial index and minimum diameter of the pulmonary artery were compared. No early or in-hospital deaths occurred, and there was no nonconfluent pulmonary artery development or segmental mal-development after a mean follow-up period of 14.9 months. Immediate pulmonary flow regulation was required in 2 patients because of excessive pulmonary flow. The mean pulmonary arterial index increased significantly from 103 mm2/m2 to 343 mm2/m2, and the mean minimum diameter of the pulmonary artery increased significantly from 2.02 mm to 4.45 mm. Four biventricular repair candidates completed definitive repair, and 2 required surgical reintervention in the pulmonary artery. Six Fontan candidates completed the Glenn procedure, and 1 completed the Fontan procedure. Three required surgical reintervention in the pulmonary artery. Two late deaths occurred after the Glenn procedure because of ventricular dysfunction and respiratory infection. Pulmonary arterial reconstruction in early infancy provides sufficient and balanced pulmonary arterial development for pulmonary atresia with pulmonary coarctation.

First-stage angioplasty for a single ventricle with pulmonary artery coarctation

We report first-stage palliation consisting of pulmonary artery angioplasty and a systemic-to-pulmonary shunt using a minimized cardiopulmonary bypass technique performed with modified ultrafiltration for two patients with a single ventricle, pulmonary atresia, patent ductus arteriosus, and pulmonary coarctation during early infancy. Postoperative early extubation (15 and 18 h) and bilateral pulmonary artery growth before the second stage (Nakata indexes, in mm2/m2: right 94, left 53; and right 209, left 70) were experienced. Less-invasive pulmonary artery continuity reconstruction at an early stage is advantageous for low-weight patients with a single ventricle and pulmonary coarctation.

Surgical strategy for pulmonary coarctation in the univentricular heart

The placement of a modified Blalock-Taussig shunt in patients suffering from pulmonary coarctation can result in the aggravation of uneven pulmonary blood flow. This may subsequently obviate the possibility of future performance of the Fontan procedure. The objective of this study was to evaluate mid-term results in patients with pulmonary coarctation who had undergone the placement of a modified Blalock-Taussig shunt, coupled with a pulmonary artery angioplasty. We retrospectively reviewed the records of 13 patients who had undergone the placement of a modified Blalock-Taussig shunt, coupled with concomitant pulmonary angioplasty, between September 1998 and August 2002. All patients received follow-up angiographic evaluations. On the ipsilateral side of the modified Blalock-Taussig shunt, we observed a significant increase in the pulmonary artery index during a mean follow-up period of 11+/-5 months (preoperative 82+/-37 mm2/m2, follow-up 129+/-57, p=0.03). On the contralateral side, we also observed a significant increase in the pulmonary artery index (preoperative 90+/-56 mm2/m2, follow-up 137+/-56, p=0.047). There was one late death. During the follow-up period (mean 23+/-18 months), 10 patients received either a bidirectional or total cavopulmonary shunt and five of these patients underwent extracardiac Fontan operations. Our study demonstrated that the placement of a modified Blalock-Taussig shunt, with concomitant pulmonary artery angioplasty, constitutes a good initial surgical strategy in cases of univentricular heart with pulmonary coarctation.

Pulmonary hypertension due to pulmonary arterial coarctation.

With improved diagnostic methods many diseases which were previously grouped together as idiopathic can now be separated into etiologic categories. Essential pulmonary hypertension may succumb to reclassification, since several types are now found to be distinguishable on the basis of definite radiological and pathological changes (1, 27, 54). It is not only our duty to refine these idiopathic categories, but it is our privilege as physiologically oriented radiologists to try and understand the basic changes which make this refinement possible (49). There have been many recent reports (2, 6, 11, 14, 20, 41, 45, 48, 51, 53, 55, 58, 60) on supravalvular or postvalvular constriction, coarctation, or stenosis of the pulmonary arteries. Four mention the association of pulmonary hypertension with this condition (2, 11, 14, 41). It is our observation that the two are always associated. Four reports have appeared in the radiologic literature. This is apropos, since coarctation of the pulmonary artery can be diagnosed radiographically. Despite the manifest recent interest in the radiological anatomy of the pulmonary arteries and in the physiology of the lesser circulation, coarctation of the pulmonary artery was not even discussed in the recent International Symposium on the Pulmonary Circulation sponsored by the Chicago Heart Association in March 1958. It seems that up to the present the relationship between pulmonary hypertension and pulmonary coarctation has not been firmly established or generally recognized. Method of Study Three general methods of study are presented: first, an analysis and review of our own cases; second, an attempt to produce pulmonary arterial coarctation anatomically and to observe the effects, if any, upon the pulmonary blood pressure; third, a review of the world literature on the pulmonary artery coarctation made in an attempt to detect patterns, similarities, or syndromes which would prove helpful in the diagnosis. From clinical and angiocardiographic observations it appeared to us that such a relationship was a very likely probability. The intermediary between the anatomical malformation and its physiologic manifestation could be a hypothetical humoral material, a neurogenic response or a hydrostatic reaction to the mechanical constriction observed. This problem seemed to invite a combined radiological and physiological experimental attack. The major premise, however, is the only one which we have tested. The secondary hypotheses are in the process of exploration. Clinical Observations Seven children who were seen in the cardiac clinics of the University of California (Los Angeles) were found to have pulmonary arterial coarctation. All of these children had pulmonary hypertension. During this same three-year period 68 other children with pulmonary hypertension were observed among 330 who had had diagnostic heart catheterization and/or angiocardiography.

Pulmonary coarctation.

Medical Journal of AustraliaVolume 1, Issue 8 p. 272-273 Reports of Cases PULMONARY COARCTATION M. L. Powell M.R.C.P., F.R.A.C.P., M. L. Powell M.R.C.P., F.R.A.C.P. MelbourneSearch for more papers by this authorH. G. Hiller M.D., M.R.A.C.P., D.D.R., M.C.R.A., H. G. Hiller M.D., M.R.A.C.P., D.D.R., M.C.R.A. MelbourneSearch for more papers by this author M. L. Powell M.R.C.P., F.R.A.C.P., M. L. Powell M.R.C.P., F.R.A.C.P. MelbourneSearch for more papers by this authorH. G. Hiller M.D., M.R.A.C.P., D.D.R., M.C.R.A., H. G. Hiller M.D., M.R.A.C.P., D.D.R., M.C.R.A. MelbourneSearch for more papers by this author First published: 01 February 1955 https://doi.org/10.5694/j.1326-5377.1955.tb88650.xCitations: 16AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume1, Issue8February 1955Pages 272-273 RelatedInformation