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Safety and Feasibility of the Transcatheter Approach to Create a Reverse Potts Shunt in Children With Idiopathic Pulmonary Arterial Hypertension.

Abstract The reversed Potts shunt improves right ventricular (RV) function in patients with suprasystemic pulmonary arterial hypertension (PAH). The proximity of the left pulmonary artery (LPA) to the descending aorta (DAo) permits the creation of a transcatheter connection. We sought to assess the safety, feasibility, and hemodynamic efficacy of the transcatheter Potts shunt (TPS) in children.
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Authors

Mayor MeshTerms

Stents

Keywords
Journal Title the canadian journal of cardiology
Publication Year Start




PMID- 28843329
OWN - NLM
STAT- MEDLINE
DA  - 20170827
DCOM- 20170901
LR  - 20170901
IS  - 1916-7075 (Electronic)
IS  - 0828-282X (Linking)
VI  - 33
IP  - 9
DP  - 2017 Sep
TI  - Safety and Feasibility of the Transcatheter Approach to Create a Reverse Potts
      Shunt in Children With Idiopathic Pulmonary Arterial Hypertension.
PG  - 1188-1196
LID - S0828-282X(17)30310-0 [pii]
LID - 10.1016/j.cjca.2017.06.004 [doi]
AB  - BACKGROUND: The reversed Potts shunt improves right ventricular (RV) function in 
      patients with suprasystemic pulmonary arterial hypertension (PAH). The proximity 
      of the left pulmonary artery (LPA) to the descending aorta (DAo) permits the
      creation of a transcatheter connection. We sought to assess the safety,
      feasibility, and hemodynamic efficacy of the transcatheter Potts shunt (TPS) in
      children. METHODS: The TPS procedure was performed using radiofrequency energy
      for vessel perforation and deployment of a covered stent to connect the DAo and
      LPA. Procedural details and clinical follow-up data were collected prospectively.
      RESULTS: A TPS was successfully created in 6 children (mean age, 11.0 +/- 4.2
      years) with drug-refractory suprasystemic PAH and deteriorating RV function. All 
      patients exhibited nearly complete equalization of aortic and pulmonary pressures
      and improvement in RV contractility within days after TPS placement. Two patients
      with pre-existing severe biventricular dysfunction and pericardial effusion
      experienced acute low-output states immediately after shunt creation because of
      sudden reductions in left ventricular (LV) preload, resulting in cardiac arrest, 
      irreversible brain damage, and death. Stent dislodgement and embolization into
      the iliac artery occurred in 1 patient. The stent was successfully secured and
      followed by placement of a second stent at the target location. The procedure was
      uncomplicated in 4 patients, who remain alive after a mean follow-up of 10 +/-
      2.6 months. Intravenous vasodilator therapy was weaned uneventfully after TPS in 
      3 patients. CONCLUSIONS: TPS creation in children is feasible and results in
      hemodynamic improvement. Further insights into high-risk markers, such as reduced
      preprocedural LV function and preload reserves, are important for guiding patient
      selection.
CI  - Copyright (c) 2017 Canadian Cardiovascular Society. Published by Elsevier Inc.
      All rights reserved.
FAU - Boudjemline, Younes
AU  - Boudjemline Y
AD  - Unite Medico-Chirurgicale de Cardiologie Congenitale et Pediatrique, Centre de
      Reference Malformations Cardiaques Congenitales Complexes-M3C, Hopital
      Universitaire Necker Enfants Malades, Assistance Publique des Hopitaux de Paris, 
      Paris, France; Universite Paris V Descartes, Sorbonne Paris Cite, Paris, France. 
      Electronic address: [email protected]
FAU - Sizarov, Aleksander
AU  - Sizarov A
AD  - Unite Medico-Chirurgicale de Cardiologie Congenitale et Pediatrique, Centre de
      Reference Malformations Cardiaques Congenitales Complexes-M3C, Hopital
      Universitaire Necker Enfants Malades, Assistance Publique des Hopitaux de Paris, 
      Paris, France.
FAU - Malekzadeh-Milani, Sophie
AU  - Malekzadeh-Milani S
AD  - Unite Medico-Chirurgicale de Cardiologie Congenitale et Pediatrique, Centre de
      Reference Malformations Cardiaques Congenitales Complexes-M3C, Hopital
      Universitaire Necker Enfants Malades, Assistance Publique des Hopitaux de Paris, 
      Paris, France.
FAU - Mirabile, Cristian
AU  - Mirabile C
AD  - Unite Medico-Chirurgicale de Cardiologie Congenitale et Pediatrique, Centre de
      Reference Malformations Cardiaques Congenitales Complexes-M3C, Hopital
      Universitaire Necker Enfants Malades, Assistance Publique des Hopitaux de Paris, 
      Paris, France.
FAU - Lenoir, Marien
AU  - Lenoir M
AD  - Unite Medico-Chirurgicale de Cardiologie Congenitale et Pediatrique, Centre de
      Reference Malformations Cardiaques Congenitales Complexes-M3C, Hopital
      Universitaire Necker Enfants Malades, Assistance Publique des Hopitaux de Paris, 
      Paris, France.
FAU - Khraiche, Diala
AU  - Khraiche D
AD  - Unite Medico-Chirurgicale de Cardiologie Congenitale et Pediatrique, Centre de
      Reference Malformations Cardiaques Congenitales Complexes-M3C, Hopital
      Universitaire Necker Enfants Malades, Assistance Publique des Hopitaux de Paris, 
      Paris, France.
FAU - Levy, Marilyne
AU  - Levy M
AD  - Unite Medico-Chirurgicale de Cardiologie Congenitale et Pediatrique, Centre de
      Reference Malformations Cardiaques Congenitales Complexes-M3C, Hopital
      Universitaire Necker Enfants Malades, Assistance Publique des Hopitaux de Paris, 
      Paris, France.
FAU - Bonnet, Damien
AU  - Bonnet D
AD  - Unite Medico-Chirurgicale de Cardiologie Congenitale et Pediatrique, Centre de
      Reference Malformations Cardiaques Congenitales Complexes-M3C, Hopital
      Universitaire Necker Enfants Malades, Assistance Publique des Hopitaux de Paris, 
      Paris, France; Universite Paris V Descartes, Sorbonne Paris Cite, Paris, France.
LA  - eng
PT  - Journal Article
DEP - 20170613
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
SB  - IM
MH  - Adolescent
MH  - Anastomosis, Surgical/methods
MH  - Aorta, Thoracic/*surgery
MH  - Catheterization, Peripheral/*methods
MH  - Child
MH  - Child, Preschool
MH  - Familial Primary Pulmonary Hypertension/physiopathology/*surgery
MH  - Feasibility Studies
MH  - Female
MH  - Femoral Artery
MH  - Femoral Vein
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Prospective Studies
MH  - Pulmonary Artery/*surgery
MH  - *Stents
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Surgical Procedures/*methods
MH  - Ventricular Function, Right/physiology
EDAT- 2017/08/28 06:00
MHDA- 2017/09/02 06:00
CRDT- 2017/08/28 06:00
PHST- 2016/12/12 [received]
PHST- 2017/06/08 [revised]
PHST- 2017/06/08 [accepted]
AID - S0828-282X(17)30310-0 [pii]
AID - 10.1016/j.cjca.2017.06.004 [doi]
PST - ppublish
SO  - Can J Cardiol. 2017 Sep;33(9):1188-1196. doi: 10.1016/j.cjca.2017.06.004. Epub
      2017 Jun 13.