Intraoperative pulmonary artery stenting: an alternative technique for the management of pulmonary artery stenosis.

BACKGROUND: Pulmonary artery reconstruction remains a challenging clinical problem. We sought to evaluate the use of intraoperative stenting in conjunction with open heart surgical repairs. METHODS: We retrospectively analyzed data from 22 patients between 1998 and 2003 who underwent intraoperative pulmonary artery stenting. RESULTS: The mean age was 9.3 years (range, 9 months to 24 years). The left pulmonary artery was stented in 8 patients, the right in 13, the main in 1, and bilateral in 1. Available echocardiograms in 20 patients revealed a mean preoperative diameter of 7.6 mm (range, 3 to 16.5 mm) and a mean peak gradient of 45.4 mm Hg (range, 20 to 120 mm Hg). Augmentation patch angioplasty of the contralateral pulmonary artery was performed in 11 patients. Thirteen patients had pulmonary valve replacement and 11 had conduit replacement or augmentation. Three patients underwent tricuspid valve repair, 6 had Fontan, and 4 underwent a modified Maze procedure. Follow-up echocardiograms demonstrated a decrease in mean peak gradient to 4.3 mm Hg (range, 0 to 15 mm Hg), a change in mean peak gradient of 41.1 mm Hg (93% reduction). After stenting the mean pulmonary artery diameter increased to 10.9 mm (range, 6 to 17.9 mm). There was no perioperative mortality. At a mean follow-up of 22.8 months (range, 6 to 57 months), there were no surgical or percutaneous reinterventions. CONCLUSIONS: Intraoperative pulmonary artery stenting is a safe and effective technique that can be used as an alternative to patch angioplasty. Close follow-up is needed to examine the long-term outcome of this procedure, with special attention to the growth and development of the stented vessel.

Duke Scholars

Author Neel Kapadia Emergency Medicine