Abstract
Objective. To evaluate the result of stenting of the right ventricle outflow tract (RVOT) of the hybrid method through a median sternotomy and right ventricle of the heart.
Material and methods. Five infants were admitted to the Federal Center of Cardiovascular Surgery in Krasnoyarsk with severe critical obstruction of the RVOT and other congenital malformations with a poor prognosis for survival. All infants were critically ill with constant infusion of prostaglandin E: 3 of them were on a prolong ventilator support with oxygen desaturation to 60%, 3 patients had sepsis. Stenting of RVOT was performed through median sternotomy and right ventricular free wall punction. In the case of the pulmonary artery atresia, perforation of the membrane was performed with an obtuse needle from (Biometrix, Angio-Linetm devise) percutaneous transluminal coronary angioplasty set under direct transesophagial echocardiography (TEE) control. Pulmonary artery valve diameter assessment has been performing while contrast agent infused into the RVOT. Metal stent size selection was based on pulmonary artery diameter +1 mm. In some cases, using of TEE or contrast agent infusion were avoided due to severe comorbidities of patients.
Results. All hybrid procedures were extremely effective and with gain in oxygen saturation in the range of 84 to 100%. One patient had cardiopulmonary reanimation and required extracorporal membrane oxygenation 2 days after hybrid surgery due to low cardiac output syndrome. The next stage of palliation as a systemic-pulmonary shunt was additionally required in two patients in 2 months of follow up. Full repair of congenital heart disease (CHD) in a 1 patient was possible in a 14 months later.
Conclusion. The hybrid approach for RVOT obstruction is an alternative option for critically ill newborns with multiple congenital malformations which may allow them to survive to full correction of the CHD. It can be used instead of open heart surgery, giving the chance for survival from our medical staff point. It gives a time for treatment other congenital comorbidities.
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About the authors
- Il'in Aleksey Sergeevich, Cand. Med. Sc., Head of Department, orcid.org/0000-0003-3252-0505;
- Teplov Pavel Viktorovich, Cardiovascular Surgeon, orcid.org/0000-0002-8798-4975;
- Sakhnov Evgeniy Vladimirovich, Endovascular Surgeon, orcid.org/0000-0002-6951-4259;
- Sakovich Valeriy Anatol'evich, Dr Med. Sc., Professor, Chief Physician, orcid.org/0000-0002-1779-325X
