This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Santoro, G. Articles by Calabrò, R. PubMed Articles by Santoro, G. Articles by Calabrò, R. Related Collections Related Article

CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Pulmonary Artery Growth After Palliation of Congenital Heart Disease With Duct-Dependent Pulmonary Circulation

Arterial Duct Stenting Versus Surgical Shunt

Giuseppe Santoro, MD^_*,_*, Giovanbattista Capozzi, MD^_*, Giuseppe Caianiello, MD, Maria Teresa Palladino, MD^_*, Chiara Marrone, MD, Gabriella Farina, MD, Maria Giovanna Russo, MD^_* and Raffaele Calabrò, MD^_*

^_* Cardiology, A.O. Monaldi, Second University of Naples, Naples, Italy
Pediatric Cardiac Surgery, A.O. Monaldi, Second University of Naples, Naples, Italy
Clinical Medicine, Cardiovascular and Immunologic Sciences, Federico II University of Naples, Naples, Italy

Manuscript received May 7, 2009; revised manuscript received July 13, 2009, accepted July 20, 2009.

^_* Reprint requests and correspondence: Dr. Giuseppe Santoro, Division of Cardiology, A.O. "Monaldi," Second University of Naples, Via Vito Lembo 14, 84131 Salerno, Italy (Email: santoropino{at}tin.it).

Objectives: The aim of this study was to compare the pulmonary artery (PA) growth after arterial duct (AD) stenting versus modified Blalock-Taussig shunt (MBTS) in neonates with congenital heart disease with duct-dependent pulmonary circulation (CHD-DPC).

Background: Arterial duct stenting is increasingly deemed a reliable alternative to surgical shunt in CHD-DPC. A stented duct might better adapt to the PA anatomy than a surgical conduit, thereby promoting a more uniform PA development.

Methods: This study enrolled 27 patients with CHD-DPC submitted to AD stenting (n = 13, Group I) or MBTS (n = 14, Group II) at our institution. The PA growth was angiographically assessed with the Nakata and McGoon indexes as well as the individual PA z-scores. The right-to-left PA diameter ratio was considered as index of uniform growth.

Results: After 10 ± 5 months, both options had promoted a significant increase of the Nakata index (from 136 ± 72 mm/m² to 294 ± 99 mm/m², p < 0.0001, Group I; from 151 ± 74 mm/m² to 295 ± 177 mm/m², p < 0.003, Group II) and McGoon ratio (from 1.5 ± 0.3 to 2.1 ± 0.3, p < 0.0001, Group I; from 1.6 ± 0.3 to 2.0 ± 0.5, p < 0.01, Group II). However, the surgical shunt had caused a worsening of the left-to-right PA diameter ratio compared with AD stenting (0.9 ± 0.1 Group I vs. 1.6 ± 0.9 Group II, p < 0.01), due to preferential growth of the PA contralateral to the shunt.

Conclusions: Percutaneous AD stenting is as effective as MBTS in promoting a global PA growth in CHD-DPC. In addition, it ensures an even distribution of the pulmonary blood flow, thereby promoting a more balanced pulmonary vascular development than MBTS.

Key Words: arterial duct • congenital heart disease • cyanosis • pulmonary artery growth • shunt • stent

Abbreviations and Acronyms   AD = arterial duct   Ao = aorta   CHD-DPC = congenital heart disease with duct-dependent pulmonary circulation   LPA = left pulmonary artery   MBTS = modified Blalock-Taussig shunt   PA = pulmonary artery   RPA = right pulmonary artery

Related Article

Inside This Issue
J. Am. Coll. Cardiol. 2009 54: A38. [Full Text] [PDF]