Revista espanola de cardiologia · 1997
[Angioplasty of residual lesions after correcting surgery of transposition of great vessels].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод пока не подготовлен
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González Barrero A J, Santos de Soto J, Descalzo Señorans A
Аннотация
BACKGROUND: Surgical correction in infants born with transposition of the great arteries, venous rerouting procedure (Mustard or Senning operation) or an arterial switch operation, can be complicated by vascular narrowings. Balloon dilatation angioplasty may be the treatment for these stenotic lesions and is attempted to avoid a reoperation of these patients.
MATERIAL AND METHODS: Angioplasty was attempted in nine patients after the surgical correction of transposition of the great arteries. Senning procedure was performed in sixty-one patients; two patients (3.2%) were successfully balloon-dilated for systemic venous obstruction: superior vena caval obstruction (case 1) and inferior vena caval obstruction (case 2). Arterial switch operation was performed in forty patients, balloon angioplasty was attempted in seven patients (17.5%) who developed supravalvar pulmonary artery stenosis. Mean age at dilation was 32.5 +/- 20.7 months (range 11 to 67) in the switch arterial group. Age at dilation in the Senning group was 8 and 106 months. The balloon/stenosis diameter was 2 to 3 in the switch arterial operation and 3 to 8 in the Senning procedure.
RESULTS: Balloon dilatation angioplasty was successful in three patients with supravalvar pulmonary stenosis postarterial switch operation (mean age was 16.6 months) and reduced the peak-to-peak gradient from 78.6 +/- 36.6 mmHg to 44 +/- 15 mmHg. There was no success after angioplasty in three patients and it was not possible to cross the stenosis with the guidewire in one (mean age was 46 months). Balloon dilatation angioplasty was successful in the obstruction following Senning procedure.
CONCLUSIONS: These data indicate that although the success rate of balloon angioplasty for supravalvar pulmonary stenosis after the arterial switch operation is low, balloon angioplasty can be the first therapeutic choice owing to its low complication rate and the potential benefit of the procedure. The success rate should be higher if angioplasty is performed at a younger age after operating and a balloon of adequate size is used. Postoperative systemic venous obstructions can be successfully managed with balloon dilatation.
MATERIAL AND METHODS: Angioplasty was attempted in nine patients after the surgical correction of transposition of the great arteries. Senning procedure was performed in sixty-one patients; two patients (3.2%) were successfully balloon-dilated for systemic venous obstruction: superior vena caval obstruction (case 1) and inferior vena caval obstruction (case 2). Arterial switch operation was performed in forty patients, balloon angioplasty was attempted in seven patients (17.5%) who developed supravalvar pulmonary artery stenosis. Mean age at dilation was 32.5 +/- 20.7 months (range 11 to 67) in the switch arterial group. Age at dilation in the Senning group was 8 and 106 months. The balloon/stenosis diameter was 2 to 3 in the switch arterial operation and 3 to 8 in the Senning procedure.
RESULTS: Balloon dilatation angioplasty was successful in three patients with supravalvar pulmonary stenosis postarterial switch operation (mean age was 16.6 months) and reduced the peak-to-peak gradient from 78.6 +/- 36.6 mmHg to 44 +/- 15 mmHg. There was no success after angioplasty in three patients and it was not possible to cross the stenosis with the guidewire in one (mean age was 46 months). Balloon dilatation angioplasty was successful in the obstruction following Senning procedure.
CONCLUSIONS: These data indicate that although the success rate of balloon angioplasty for supravalvar pulmonary stenosis after the arterial switch operation is low, balloon angioplasty can be the first therapeutic choice owing to its low complication rate and the potential benefit of the procedure. The success rate should be higher if angioplasty is performed at a younger age after operating and a balloon of adequate size is used. Postoperative systemic venous obstructions can be successfully managed with balloon dilatation.