Comparison of pulmonary artery growth between ductus stent and systemic to pulmonary shunt as single-ventricle palliation
Presented During:
Sunday, April 28, 2024: 10:54AM - 11:01AM
Metro Toronto Convention Center
Posted Room Name:
Room 716
Abstract No:
142
Submission Type:
Abstract Submission
Authors:
Dimitrij Grozdanov (1), Takuya Osawa (1), Thibault Schaeffer (1), Jonas Palm (2), Paul Philipp Heinisch (1), Alfred Hager (2), Peter Ewert (2), Jürgen Hörer (1), Masamichi Ono (1)
Institutions:
(1) German Heart Center Munich, Munich, Germany, (2) Department of Pediatric Cardiology and Congenital Heart Disease, Munich, Germany
Submitting Author:
Dimitrij Grozdanov
-
Contact Me
German Heart Center Munich
German Heart Center Munich
Co-Author(s):
Takuya Osawa
-
Contact Me
German Heart Center Munich
German Heart Center Munich
Thibault Schaeffer
-
Contact Me
German Heart Center Munich
German Heart Center Munich
Jonas Palm
-
Contact Me
Department of Pediatric Cardiology and Congenital Heart Disease
Department of Pediatric Cardiology and Congenital Heart Disease
Paul Philipp Heinisch
-
Contact Me
German Heart Center Munich
German Heart Center Munich
Alfred Hager
-
Contact Me
Department of Pediatric Cardiology and Congenital Heart Disease
Department of Pediatric Cardiology and Congenital Heart Disease
Peter Ewert
-
Contact Me
Department of Pediatric Cardiology and Congenital Heart Disease
Department of Pediatric Cardiology and Congenital Heart Disease
Jürgen Hörer
-
Contact Me
German Heart Center Munich
German Heart Center Munich
Masamichi Ono
-
Contact Me
German Heart Center Munich
German Heart Center Munich
Presenting Author:
Dimitrij Grozdanov
-
Contact Me
N/A
N/A
Abstract:
Objective: We aimed to compare the pulmonary artery (PA) growth between infants with univentricular hearts who underwent a ductus stenting and those who received a surgical systemic to pulmonary shunt.
Methods: All infants with univentricular heart and ductal-dependent pulmonary blood flow who underwent initial palliation with either a ductus stenting (DS) or a surgical systemic to pulmonary shunt (SPS) between 2009 and 2022 were reviewed. Patients who underwent SPS and concomitantly repair of total anomalous pulmonary venous connection and/or aortic arch repair were excluded. PA development was compared between the groups and the using the PA index after Nakata, ratio of left to right PA index, and the symmetry index after Gratz.
Results: A total of 130 patients were evaluated, and patients were divided into 2 groups: 39 patients who underwent ductus stenting (DS group) and 91 patients who underwent systemic to pulmonary shunts (SPS group). SPS group included 10 patients who initially performed DS and switched to SPS due to the dislocation or dysfunction of DS. The most frequent primary diagnosis was tricuspid atresia in 27, followed by pulmonary atresia with intact ventricular septum in 19, and double inlet left ventricle in 18 patients. At the time of the initial procedure, PA index (p=0.43), right PA index (p=0.81), and left PA index (P=26) were similar between the groups. The rate of reaching stage II palliation was similar between the groups (87.2 vs. 82.4%, p=0.50). At stage II palliation, the PA index (p=0.73), right PA index (p=0.32), left PA index (p=0.633), and symmetry index (p=0.83) were similar between the groups (Figure). However, the ratio of left to right PA index was lower in DS group compared to SPS group (p=0.02). At stage III Fontan completion, PA index (p=0.50), right PA index (p=0.61), left PA index (p=0.12), symmetry index (p=0.32) and the ratio of left to right PA index (p=0.06) were similar between DS and SPS group. The incidence of the development of aortopulmonary collaterals (28.6 vs. 48.3%, p=0.08) and venovenous collaterals (21.4 vs. 10.3%, p=0.17) were also similar between DS and SPS group.
Conclusions:
After successful ductus stenting in infants with univentricular heart, the development of pulmonary arteries is comparable to those after surgical systemic to pulmonary shunt. The impaired left PA development in the long-term might be a concern after ductus stent.
Methods: All infants with univentricular heart and ductal-dependent pulmonary blood flow who underwent initial palliation with either a ductus stenting (DS) or a surgical systemic to pulmonary shunt (SPS) between 2009 and 2022 were reviewed. Patients who underwent SPS and concomitantly repair of total anomalous pulmonary venous connection and/or aortic arch repair were excluded. PA development was compared between the groups and the using the PA index after Nakata, ratio of left to right PA index, and the symmetry index after Gratz.
Results: A total of 130 patients were evaluated, and patients were divided into 2 groups: 39 patients who underwent ductus stenting (DS group) and 91 patients who underwent systemic to pulmonary shunts (SPS group). SPS group included 10 patients who initially performed DS and switched to SPS due to the dislocation or dysfunction of DS. The most frequent primary diagnosis was tricuspid atresia in 27, followed by pulmonary atresia with intact ventricular septum in 19, and double inlet left ventricle in 18 patients. At the time of the initial procedure, PA index (p=0.43), right PA index (p=0.81), and left PA index (P=26) were similar between the groups. The rate of reaching stage II palliation was similar between the groups (87.2 vs. 82.4%, p=0.50). At stage II palliation, the PA index (p=0.73), right PA index (p=0.32), left PA index (p=0.633), and symmetry index (p=0.83) were similar between the groups (Figure). However, the ratio of left to right PA index was lower in DS group compared to SPS group (p=0.02). At stage III Fontan completion, PA index (p=0.50), right PA index (p=0.61), left PA index (p=0.12), symmetry index (p=0.32) and the ratio of left to right PA index (p=0.06) were similar between DS and SPS group. The incidence of the development of aortopulmonary collaterals (28.6 vs. 48.3%, p=0.08) and venovenous collaterals (21.4 vs. 10.3%, p=0.17) were also similar between DS and SPS group.
Conclusions:
After successful ductus stenting in infants with univentricular heart, the development of pulmonary arteries is comparable to those after surgical systemic to pulmonary shunt. The impaired left PA development in the long-term might be a concern after ductus stent.
CONGENTIAL:
Single Ventricle Management
Image or Table
