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Percutaneous Stent Implantation for Occluded Central Shunts in Adults: A Case Report and Review of Current Evidence Publisher



Jenab Y1 ; Rezaee M1, 2 ; Hosseini K1 ; Ghaderian H1 ; Haddad RN3 ; Zaidi AN4
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Authors Affiliations
  1. 1. Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Hopital Universitaire Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris (AP-HP), Paris, France
  4. 4. Mount Sinai Adult Congenital Heart Disease Center, Icahn School of Medicine, New York, NY, United States

Source: Frontiers in Cardiovascular Medicine Published:2022


Abstract

Background: Patients with cyanotic complex congenital heart defects (CHDs) commonly undergo palliation with interposition of systemic-to-pulmonary shunts (SPSs). These palliative shunts are rarely found in adults with CHDs and can be complicated with progressive obstruction or total occlusion during follow-up. The best treatment option for shunt re-permeabilization is challenging and case-oriented because most patients are high risk candidates for redo surgeries. We aimed to review the current evidence on percutaneous stent implantation to treat failed SPSs. Methods: We performed a comprehensive literature review on percutaneous stent implantation to treat failed and occluded SPSs. We also reported the case of a 33-year-old man with cyanotic CHD and a occluded central aorto-pulmonary shunt, who was successfully treated with percutaneous balloon dilatation and subsequently stent implantation at our institution. Result: We identified and included 31 articles reporting on 150 patients and 165 stent implantations in failed SPSs. The age of patients at the time of stent implantation ranged from 6 days to 47 years. The time between the surgical shunt creation and transcatheter intervention ranged from 1 day to 17 years. Overall, 161/165 (97.5%) stent implantations were successful. The most common clinical presentation was cyanosis and decreased atrial oxygen saturations and the indication for stent implantation was shunt obstruction and stenosis. Conclusion: This review highlights the benefits of endovascular stenting to permeabilize failed SPSs in children and adults with complex CHD who are classified as poor candidates for re-surgical repair. Copyright © 2022 Jenab, Rezaee, Hosseini, Ghaderian, Haddad and Zaidi.