Stents as Bridge to Arterial Switch Operation for D-Transposition of Great Arteries Late Presenter

Abstract

We report a 5-month-old infant with dextro-transposition of great arteries (D-TGA) with intact ventricular septum (IVS) who had low left ventricular mass index, small patent ductus arteriosus (PDA), and stretched patent foramen ovale. The patient had respiratory failure due to pneumonia. The surgical intervention was considered very high risk. Thus, the patient underwent PDA stenting with balloon predilation technique followed by atrial septal stenting with false impression of dislodgement—“pseudo-dislodgement” because of inadvertent retraction of patent foramen ovale that was confirmed by transthoracic echocardiography guidance. After the procedure, the left ventricular mass index improved and patient was planned for arterial switch operation. The combined approach of PDA and atrial septal stenting may provide potential nonsurgical method of ventricular preparation for D-TGA/IVS late presenter, acting as a bridge to arterial switch operation especially those living in remote areas.

Keywords

transposition of great arteries - bridge to surgery - ductal stenting - atrial septal stenting

Note

Informed parental consent was obtained.

Publication History

Article published online:
11 March 2021

• References

• 1 Rao PS. Management of congenital heart disease: state of the art—part II—cyanotic heart defects. Children (Basel) 2019; 6 (04) 54
• 2 Hascoët S, Baruteau A, Jalal Z. et al. Stents in paediatric and adult congenital interventional cardiac catheterization. Arch Cardiovasc Dis 2014; 107 (8-9): 462-475
• 3 Myers JW, Ghanayem NS, Cao Y. et al. Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: analysis of shunt type, size, and surgical approach. J Thorac Cardiovasc Surg 2014; 147 (02) 672-677
• 4 Alwi M. Stenting the ductus arteriosus: case selection, technique and possible complications. Ann Pediatr Cardiol 2008; 1 (01) 38-45
• 5 Cinteza E, Carminati M. Balloon atrial septostomy - almost half a century after. Maedica (Bucur) 2013; 8 (03) 280-284
• 6 Baer GM, Wilson TS, Small IV W. et al. Thermomechanical properties, collapse pressure, and expansion of shape memory polymer neurovascular stent prototypes. J Biomed Mater Res B Appl Biomater 2009; 90 (01) 421-429
• 7 Food and Drug Administration. Summary of safety and effectiveness data. 2011 . Accessed October 28, 2020 at: https://www.accessdata.fda.gov/cdrh_docs/pdf11/P110001b.pdf
• 8 Kumar N, Shaikh AS, Kumari V, Patel N. Echocardiography guided bed side balloon atrial septostomy in dextro transposed great arteries (dTGA) with intact ventricular septum (IVS): a resource limited country experience. Pak J Med Sci 2018; 34 (06) 1347-1352
• 9 Marshall AC, Lock JE. Structural and compliant anatomy of the patent foramen ovale in patients undergoing transcatheter closure. Am Heart J 2000; 140 (02) 303-307