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Impact of stent implantation on pulmonary artery growth
Cheryl M Takao1, Howaida El Said, Dana Connolly
1Children's Hospital Los Angeles, Division of Cardiology, Los Angeles, CA, 90027.
Insights
Stent implantation effectively promotes pulmonary artery growth in children with pulmonary artery stenosis. Early stenting benefits both single ventricle and two-ventricle patients, encouraging normal lobar development.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Pulmonary artery (PA) stenosis in children necessitates interventions to improve distal vasculature flow.
- Stent implantation (SI) aims to relieve obstruction and enhance PA growth.
- Evaluating the impact of SI on distal PA growth is crucial for pediatric cardiac care.
Purpose of the Study:
- To assess the effect of stent implantation on the growth of distal pulmonary arteries in pediatric patients with PA stenosis.
- To compare the growth of stented pulmonary arteries with non-stented contralateral pulmonary arteries as a control.
- To determine if early and aggressive stenting promotes lobar branch growth.
Main Methods:
- Retrospective analysis of pediatric patients (1998-2009) who underwent unilateral SI for PA stenosis.
- Comparison of stented PA (SPA) and contralateral PA (CPA) diameters at initial and follow-up catheterizations.
- Analysis of upper lobe (UL) and lower lobe (LL) PA growth in single ventricle (SV) and two-ventricle (2V) patients.
Main Results:
- In single ventricle patients (N=18), stented PA diameter increased by 118%. Initial follow-up showed comparable UL and LL growth between SPA and CPA.
- Subsequent follow-up in SV patients revealed continued comparable growth of SPA and CPA in both lobes.
- In two-ventricle patients (N=21), stented PA diameter increased by 100%. Follow-up showed similar UL and LL growth initially, but significantly greater UL growth in SPA compared to CPA at later follow-up.
Conclusions:
- Stent implantation is effective in promoting normal lobar growth in pediatric patients with PA stenosis, regardless of ventricle type.
- Two-ventricle patients demonstrated greater lobar growth compared to single ventricle patients at the first follow-up.
- Early and aggressive pulmonary artery stenting is beneficial for promoting lobar branch growth in children.
Background:
Goals of stent implantation (SI) in children with pulmonary artery (PA) stenosis are to relieve obstruction and improve flow to the distal vasculature. We evaluated stent impact on distal PA growth.
Methods:
We compared data of children who underwent unilateral SI using the nonstenotic contralateral PA (CPA) as a control (1998-2005; f/u data through 2009). Main/lobar diameters measured at initial and f/u catheterizations were analyzed.
Results:
For single ventricle (SV) patients (N = 18), the stented PA diameter (SPA D) increased 118%. At initial f/u catheterization (14 ± 9.6 months), both upper lobe (UL) and lower lobe (LL) growth of SPA was comparable to those of the CPA (UL:7% vs. 7%; P = 0.97); (LL:5% vs. 10%; P = 0.33). Subsequent f/u in 11/18 patients (mean 26 ± 20 months) revealed similar results: both UL and LL growth of SPA were comparable to those of the CPA (UL:51% vs. 27%; P = 0.3); (LL:18% vs. 21%; P = 0.62). For two-ventricle (2V) patients (N = 21), the SPAD increased 100%. At f/u, UL, and LL growth on SPA was similar to those of the CPA (UL: 32% vs. 21%; P = 0.37); (LL: 17% vs. 18%; P = 0.88). Subsequent f/u in 10/21 patients (mean 34 ± 14 months) showed UL growth of SPA was significantly greater than that of the CPA (44% vs. 21%; P = 0.05). LL growth of SPA was similar to that of the CPA (19% vs. 14%; P = 0.56).
Conclusion:
SI for PA stenosis is effective in promoting normal lobar growth in SV and 2V patients. Greater lobar growth was seen in 2V compared to SV pts at first f/u. Early, aggressive PA stenting is beneficial in promoting lobar branch growth.
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