Outcomes of Patent Ductus Arteriosus Stenting to Retrain Regressed Left Ventricle in Transposition of Great Arteries with Intact Ventricular Septum
DOI:
https://doi.org/10.51253/pafmj.v75iSUPPL-3.12673Keywords:
Intact Ventricular Septum, Modified Blalock Taussig Shunt, Patent Ductus Arteriosus, Regressed left ventricle, Transposition of Great ArteriesAbstract
Objective: To assess the outcomes of Patent Ductus Arteriosus (PDA) stenting to retrain regressed Left Ventricle (LV) in Transposition of Great Arteries with Intact Ventricular Septum (TGA-IVS).
Study Design: Quasi-experimental study
Place and Duration of Study: Paediatric Cardiology Department, Armed Forces Institute of Cardiology & National Institute of Heart Diseases, Rawalpindi Pakistan from July-Dec 2023
Methodology: Thirty pediatric patients aged < 2 months who underwent PDA stenting with TGA-IVS having regressed LV were included using non probability consecutive sampling. Prior to PDA stenting, echocardiography was performed in all TGA-IVS patients to evaluate the effectiveness of LV retraining.The Mosteller formula was used to relate LV mass to body surface area. Echocardiographic LV assessment was repeated at 1st and 2nd week after PDA stenting. Post stenting angiogram was carried out to confirm optimum placement and adequate blood flow to branch pulmonary arteries.
Results: Among 30 participants, 19(63.3%) patients were males and 11(36.7%) were females with composite median age of 10.00(6.50-32.50) days. LV retraining using PDA stenting was found to be successful in 27(90.0%) patients and unsuccessful in 3(10.0%) patients. Successful patients exhibited high LV mass index [Pre stenting vs. post stenting: 33.00(32.00-34.00) g/m2 vs. 63.00(61.00-65.00) g/m2; p=0.005] and improved LV geometry after PDA stenting. However, the unsuccessful patients did not show an appropriate response because of large interatrial communication.
Conclusions: PDA stenting significantly improved both left ventricular mass index and LV geometry. Moreover, transcatheter ductal stenting was an effective and safe method to retrain the regressed LV in late presenters of TGA-IVS.
Downloads
References
Komarlu R, Morell VO, Kreutzer J, Munoz RA. Dextro-transposition of the great arteries (D-TGA). Critical Care of Children with Heart Disease: Basic Medical and Surgical Concepts. 2020:351-367.
https://doi.org/10.1007/978-3-030-21870-6_32
Soran Türkcan B, Yılmaz M, Özdemir Şahan Y, Ertekin Ö, Ecevit AN, Atalay A. Transposition of the great arteries: single center experiences. Anatomy. 2022;16(3):172-178.
https://doi.org/10.2399/ana.22.3282183
Rito ML, Raso I, Saracino A, Basile DP, Varrica A, Reali M, et al. Primary arterial switch operation for late presentation of transposition of the great arteries with intact ventricular septum. Semin Thorac Cardiovasc Surg. 2022;34(1):191-202. WB Saunders.https://doi.org/10.1053/j.semtcvs.2020.11.030
Mainwaring RD, Patrick WL, Arunamata A, Chan F, Newman B, Rosenblatt TR, et al. Left ventricular retraining in corrected transposition: Relationship between pressure and mass. J Thorac Cardiovasc Surg 2020;159(6):2356-2366.
https://doi.org/10.1016/j.jtcvs.2019.10.053
Leong MC, Alhassan AA, Sivalingam S, Alwi M. Ductal stenting to retrain the involuted left ventricle in d-transposition of the great arteries. Ann Thorac Surg 2019;108 (3):813-819.
https://doi.org/10.1016/j.athoracsur.2019.03.045
Duan Y, Sun Y, Dong S, Du C, Yan J. Two-stage arterial switch for transposition of the great vessels in older children. Ann Thorac Surg 2022;114 (1):193-200.
https://doi.org/10.1016/j.athoracsur.2021.04.081
Ma K, Hua Z, Yang K, Hu S,Yan J, Zhang H, et al. Arterial switch for transposed great vessels with intact ventricular septum beyond one month of age. Ann Thorac Surg. 2014;97 (1):189-195.https://doi.org/10.1016/j.athoracsur.2013.09.011
Lacour-Gayet F, Piot D, Zoghbi J, Serraf A, Gruber P, Macé L, et al. Surgical management and indication of left ventricular retraining in arterial switch for transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg. 2001;20 (4):824-829.https://doi.org/10.1016/S1010-7940(01)00897-1
Glatz AC, Petit CJ, Goldstein BH, Kelleman MS, McCracken CE, McDonnell A, et al. Comparison between patent ductus arteriosus stent and modified Blalock-Taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow: insights from the congenital catheterization research collaborative. Circulation. 2018;137 (6):589-601.
https://doi.org/10.1161/CIRCULATIONAHA.117.029987
Hussain S, Sabir MU, Afzal M, Asghar I. Incidence of congenital heart disease among neonates in a neonatal unit of a tertiary care hospital. J Pak Med Assoc. 2014;64(2):175-178.
AbdelMassih AF, Menshawey R, Menshawey E, El-Maghraby AE, Sabry AO, Kamel A,. et al. Blalock-Taussig shunt versus ductal stent in the palliation of duct dependent pulmonary circulation; a systematic review and metanalysis. Curr Probl Cardio. 2022 ;47 (9):100885.https://doi.org/10.1016/j.cpcardiol.2021.100885
Agha HM, Abd-El Aziz O, Kamel O, Sheta SS, El-Sisi A, El-Saiedi S, et al. Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. PLoS One. 2022;17(4):e0265031. https://doi.org/10.1371%2Fjournal.pone.0265031
Bilal MS, Özyüksel A, Kemal Avşar M, Demiroluk Ş, Küçükosmanoğlu O, Yalçın Y. A better approach for left ventricular training in transposition of the great arteries and intact interventricular septum: Bidirectional cavopulmonary anastomosis and pulmonary artery banding. Congenit Heart Dis. 2019;14(3):464-469.https://doi.org/10.1111/chd.12749
Cevik A, Karaci AR, Polat B, Erturk M, Yalcin Y, Yazicioglu V et al. Pulmonary artery banding and venous bidirectional cava-pulmonary shunt for two-stage arterial switch procedure in late referral of patients with transposition of the great arteries and intact ventricular septum: midterm results. Cardio Young. 2019;29 (5):649-654.
https://doi.org/10.1017/S104795111900043X
Anantharaj A, Pant BP, Thalor NS, Balasubramanian H, Coelho R. Ductal Stenting and Judicious Avoidance of Septostomy Rapidly Retrain a Regressed Left Ventricle in D Transposition: A Case Report. J Cardiovasc Imaging. 2021;29(4):375.
https://doi.org/10.4250/jcvi.2020.0209
Sarris GE, Balmer C, Bonou P, Comas JV, da Cruz E, Di Chiara L, et al. Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum: the task force on transposition of the great arteries of the European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC). Cardio Young 2017;27(3):530-569.
https://doi.org/10.1017/S1047951117000014
Kothari SS, Ramakrishnan S, Senguttuvan NB, Gupta SK, Bisoi AK. Ductal recanalization and stenting for late presenters with TGA intact ventricular septum. Ann Pediatr Cardiol 2011 ;4(2):135-138. https://doi.org/10.4103%2F0974-2069.84651
Bentham JR, Zava NK, Harrison WJ, Shauq A, Kalantre A, Derrick G, et al. Crossland D. Duct stenting versus modified Blalock-Taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter national study. Circulation. 2018;137 (6):581-588.
https://doi.org/10.1161/CIRCULATIONAHA.117.028972
Sivakumar K, Francis E, Krishnan P, Shahani J. Ductal stenting retrains the left ventricle in transposition of great arteries with intact ventricular septum. J Thorac Cardiovasc Surg. 2006 ;132(5):1081-1086.
https://doi.org/10.1016/j.jtcvs.2006.07.014
Bahaidarah S, Al-Ata J, Alkhushi N, Azhar A, Zaher Z, Alnahdi B, Abdelsalam M, Elakaby A, et al. Outcome of ductus arteriosus stenting including vertical tubular and convoluted tortuous ducts with emphasis on technical considerations. Egypt Heart J. 2021 ;73:1-10. https://doi.org/10.1186/s43044-021-00210-4
Downloads
Published
License
Copyright (c) 2025 AzizUllah ., Nadeem Sadiq, Amjad Mahmood, Muhammad Asad Farhan, Madeeha Ikram
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
