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Updated: Aug 18, 2026
Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis
Published on: August 26, 2025
Intraoperative stenting of pulmonary arteries
Regina Bökenkamp1, Nico A Blom, Daniel De Wolf
1Department of Pediatric Cardiology and Thoracic Surgery, Leiden University Medical Center, Center of Congenital Anomalies of the Heart Amsterdam/Leiden, Leiden, The Netherlands. r.bokenkamp.kjc@lumc.nl
Insights
This study shows that intraoperative stent placement is a safe and effective adjunct for complex pediatric cardiac surgery. It helps manage pulmonary artery stenoses and keeps vessels open for future interventions.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Interventional Cardiology
Background:
- Surgical repair of complex congenital heart disease in children often involves pulmonary artery stenoses, posing significant technical challenges.
- The management of these stenoses in small, fragile pulmonary vessels requires innovative approaches to ensure optimal outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of a hybrid approach combining corrective cardiac surgery with intraoperative pulmonary artery stenting in pediatric patients.
- To assess the long-term patency and outcomes of stented pulmonary arteries in this high-risk population.
Main Methods:
- A descriptive study involving 11 pediatric patients (age 1 week to 12 years) with complex cardiac lesions and pulmonary artery stenoses.
- Intraoperative stenting of pulmonary arteries was performed by a combined team of pediatric cardiologists and cardiac surgeons, alongside various cardiac repairs.
- Procedures included repair of pulmonary atresia, ventricular outflow tract reconstruction, and management of complications after previous surgeries.
Main Results:
- No intraoperative complications occurred during stent implantation.
- Ten out of eleven patients were discharged post-procedure; one patient experienced a late death due to bleeding complications.
- Stent re-dilatation was needed in 4 patients. At a median follow-up of 15 months, all stents remained patent, confirmed by angiography or echocardiography.
Conclusions:
- Intraoperative stent placement effectively manages challenging pulmonary artery stenoses in complex pediatric cardiac surgery, avoiding difficult patch augmentations.
- Pulmonary artery stents maintain vessel patency and facilitate future percutaneous or surgical interventions, improving long-term management options.
Objective:
The surgical treatment of pulmonary artery stenoses in small children with complex cardiac lesions can be technically difficult. A hybrid-approach combining corrective surgery and intraoperative stent placement may be complementary in these patients.
Methods:
Descriptive study in 11 small children (age: one week to 12 years, median of 12 months, weight: 2.5-20 kg) after previous cardiac surgery. Intraoperative stenting of pulmonary arteries was performed involving paediatric cardiologist and cardiac surgeon. Stenting was combined with repair of pulmonary atresia (n=2), right ventricular outflow and pulmonary artery reconstruction (n=3), unifocalisation of pulmonary arteries (n=1), revision of distal anastomosis of RV-PA-conduit after truncus repair (n=1), revision of distal anastomosis of RV-PA-conduit after AVSD/Fallot repair (n=1), aortic arch patch reconstruction after anatomical correction for transposition of the great arteries (n=1), bidirectional cavopulmonary anastomosis after Norwood I operation for hypoplastic left heart syndrome, (n=1) retrieval of a dislodged stent from the left pulmonary artery (n=1). In seven patients stenting was planned electively while in four patients it took place on an emergency base.
Results:
No complications occurred during stent implantation. One patient died three weeks postoperatively from diffuse bleeding due to a coagulation disorder. Ten patients left hospital after the surgical intervention with concomitant stent implantation. Stent re-dilatation was necessary in 4 patients 2-24 months postoperatively. After a median follow-up of 15 months ranging from 3 weeks to 7.5 years all stents were patent as diagnosed by angiography in 6 patients and by colour-Doppler in all other patients. One year after stent placement one stent was removed and another surgically opened during re-operation for conduit replacement in the smallest patient from this series. There was one late death during operative right ventricular outflow-tract reconstruction after initial stent placement.
Conclusions:
With intraoperative stent placement surgically difficult patch augmentation of small and fragile pulmonary vessels during repair of complex cardiac lesions can be avoided. Stents recruit pulmonary vessels and keep them open and amenable to future percutaneous or surgical interventions.