Effectiveness and safety of percutaneous transcatheter implantation of pulmonary arterial stent in congenital heart disease.

BACKGROUND AND OBJECTIVES: Pulmonary arterial stenosis is a relatively common complication after corrective operation of congenital heart disease. Unilateral stenosis of pulmonary arteries could result in decrease perfusion of affected lung, pulmonary regurgitation, or elevation of right ventricular pressure. Eventually there are increasing risks of right ventricular failure, arrhythmia, or sudden death. However we have limited data of pulmonary arterial stent in paediatric population as the treatment of branch pulmonary stenosis. This study aimed at validating the effectiveness and investigating complications of pulmonary arterial stent implantation in a single institution during mid-term follow up period. SUBJECTS AND METHODS: A total of 42 patients (50 stents) were implanted for treating branch pulmonary arterial stenosis. We used cardiac catheterization for comparing diameter after stent implantation directly and lung perfusion scan indirectly. We also investigated any adverse effect relating the procedure. RESULTS: Percent stenosis of stenotic lesions were decreased from 54.1±10.7% to 22.8±12.5% (p<0.001) and degree of decrement in affected lung perfusion was declined from 22.7±8.0% to 10.3±9.0% (p<0.001) immediately and lasts during mid-term follow up period. Complication rate relating the procedure was 12% (6 out of 12) and there was no mortality case. CONCLUSION: This series showed immediate and short term effectiveness of pulmonary arterial stent in congenital heart defects. We concluded that percutaneous transcatheter implantation of pulmonary arterial stent was safe and effective during short and mid-term follow up period.

Perivascular brightness of coronary arteries in Kawasaki disease.

OBJECTIVE: Because perivascular echo brightness (PEB) of coronary arteries has been proposed as a criterion for diagnosis of incomplete Kawasaki disease, we assessed the clinical importance of PEB during the acute phase of disease. STUDY DESIGN: We enrolled 58 patients with Kawasaki disease who underwent two-dimensional strain analysis of images of pericoronary tissue taken during the acute and the convalescent phases. Echogenicity of pericoronary tissue and of the blood pool was determined by speckle tracking in the respective areas of imaging as the averages of integrated backscatter over a single cardiac cycle. PEB was defined as echogenicity of pericoronary tissue minus blood pool. RESULTS: PEB did not differ in the acute phase in patients and control subjects (P = .10) and between phases of disease (P = .25). In comparison between patient groups, the presence of pericardial effusion was higher in patients with higher PEB during the acute phase (n = 30) than in the remaining patients (33% versus 4%, P < .01). CONCLUSIONS: PEB did not differ between patients and control subjects and is only associated with the presence of pericardial effusion during the acute phase of Kawasaki disease. Our data do not confirm the reliability of PEB as a useful diagnostic sign of incomplete Kawasaki disease.

Tetralogy of Fallot without the infundibular septum-restricted growth of the pulmonary valve annulus after annulus preservation may render the right ventricular outflow tract obstructive.

OBJECTIVE: Tetralogy of Fallot (ToF) with infundibular septal deficiency (ISD) is commonly associated with postoperative right ventricular outflow tract obstruction (RVOTO), presumably caused by subpulmonary extension of ventricular septal defect (VSD) and restricted growth of the pulmonary valve annulus (PVA). We sought to determine the postoperative growth of the PVA after annulus preservation according to the presence or absence of the infundibular septum. METHODS: A retrospective review of 90 patients who underwent surgical repair of ToF between June 1997 and August 2008 was performed. Median age at operation was 9.5 months. Infundibular septum was absent in 15 (15/90, 17%). PVA was preserved in 71 patients (71/90, 79%), including 13 patients with ISD (13/15, 87%). RESULTS: Median follow-up duration was 39 months (2 months to 13 years). There was no early mortality and one late noncardiac death. Among the patients with PVA preservation, reoperation for RVOTO was performed in 4 patients (4/71, 6%), including 3 patients without the infundibular septum. ISD was identified as the only risk factor in reoperation for RVOTO after PVA preservation (RR: 21.85, P = .007). Among the patients who underwent repair with PVA preservation during infancy (n = 43), PVA (Z-score) increased postoperatively in patients with the infundibular septum (+ 0.021/month, P = .009), whereas the changes in PVA (Z-score) were nonsignificant in patients with ISD (-0.021/month, P = .306), with a marginal intergroup difference (P = .056). CONCLUSIONS: PVA preservation in ToF with ISD may be associated with a higher risk for postoperative RVOTO, which can be attributed to the restricted growth of the PVA.