Interventional Catheterization Performed in the Early Postoperative Period After Congenital Heart Surgery in Children

JACC 2004;43:1264-9

Evan Zahn et al.

1995-2001.

62 patients underwent 66 catheterizations.

Median postop day 9 (0-42 days).

35 cases involved 50 interventions.

Median age 4 mo (2 days - 11 years)

Median weight 4.7 kg (2.3 - 45 kg)

Success rate:

Angioplasty 100%

Stent implantation 87%

Vascular/Septal occlusion 100%

Palliative pulmonary valvotomy 75%

30 procedures were Angioplasty or Stent placement. 26 of these were at recent suture lines.

Complications: Stent migration 1, CVA 1, LPA stenosis 1

30-day survival: 83% (No procedure related mortality)

LPA stenosis - stent:
BT shunt occlusion - balloon:
Notable comments in the article:

1) Balloon/Stenosis ratio - 2.5 (range 1.4 - 4.4)...similar to ratio used in Rosales et al. 2002 study (Cath Cardiovasc Interv 2002;56:272-7). Therefore, reason for 20% mortality from vessel disruption may be due to intrinsic difference in technique.

2) ...A variety of freshly sutured materials can undergo angioplasty and stent placement without vessel disruption.

Potential reasons:

a. Prolene sutures - elongates as much as 34% before breaking

b. An enlargement of the circumference of the suture line (increased distance between parallel throws) in response to balloon inflation - prevents suture breakage....we believe continuous prolene suture lines can be safely and effectively expanded with balloon/stenosis ratios of 2.5 or less...since angioplasty needs higher ratio, stent placement is preferable in early postop period.