BALLOON-EXPANDABLE STENTS FOR SYSTEMIC VENOUS PATHWAY STENOSIS LATE AFTER MUSTARDS OPERATION

Objectives-Description and evaluation of current experience with the u se of balloon expandable stents for the relief of systemic venous path way stenosis late after Mustard's operation. Design-Retrospective obse rvational study of technical procedures, angiographic, and haemodynami c findings. Patients-Twenty long term survivors of Mustard's operation for transposition of the great arteries (TGA) with angiographic evide nce of systemic venous pathway narrowing. Intervention-Systemic venous pathway stenoses were stented using balloon expandable Palmaz stents. Results-Twenty seven stents were deployed across 24 stenoses. Sevente en stents were placed in the inferior baffle (16 patients), with an in crease in mean (range) minimum diameter from 9.6 (4.5-15.9) to 16.5 (1 1.9-22.2) mm (p = 0.007), and a reduction in mean pressure gradient fr om 3.1 (0-8) to 0.67 (0-3) mmHg (p=0.002). Eight stents placed in the superior pathways of eight patients, with diameters widened from 9.1 ( 3.5-14.1) to 15.2 (8.7-19.2) mm (p = 0.018), and gradients reduced fro m 6.4 (2-11) to 0.9 (0-2) mm Hg (p = 0.02). Two badly deployed stents were safely withdrawn from their intracardiac positions and redeployed in the iliac vein. Transvenous pacemaker insertion was facilitated by prior stent insertion. Conclusions-The use of balloon expandable sten ts for late systemic pathway narrowing after Mustard's operation is sa fe and effective. The beneficial effects of stenting are likely to be more durable than those of balloon angioplasty alone, but longer term follow up is required.