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Morphological and Hemodynamic Effectiveness of Stenting for Pulmonary Artery Stenosis - Subanalysis of JPIC Stent
Takanari Fujii1, Hideshi Tomita, Kazuto Fujimoto
1Cardiovascular Center, Showa University Northern Yokohama Hospital.
Insights
Percutaneous stenting for branch pulmonary artery stenosis is effective in congenital heart disease. Reference vessel diameter and percent diameter stenosis before stenting predict successful outcomes.
Area of Science:
- Interventional Cardiology
- Congenital Heart Disease
- Pediatric Cardiology
Background:
- Percutaneous stenting is a key treatment for branch pulmonary artery stenosis in congenital heart disease.
- Morphological changes in vessel diameter after stenting may not always reflect hemodynamic improvements.
Purpose of the Study:
- To evaluate the relationship between morphological and hemodynamic effectiveness of percutaneous stenting in branch pulmonary artery stenosis.
- To identify predictors of successful stenting outcomes.
Main Methods:
- Subanalysis of data from the Japanese Society of Pediatric Interventional Cardiology (JPIC) stent survey.
- Evaluation of 206 stenting lesions, defining morphological effectiveness as a 50% increase in minimum lumen diameter (MLD).
- Defining hemodynamic effectiveness as a >50% reduction in pressure gradient or a >20% increase in perfusion ratio.
Main Results:
- Morphological effectiveness was achieved in 84% of patients.
- Pre-stenting reference vessel diameter (RVD) and percent diameter stenosis (%DS) were significant predictors of effectiveness.
- Effective stenting was associated with a %DS cutoff of 51% and RVD of 14.7 mm.
Conclusions:
- RVD and %DS are crucial factors for acute morphological effectiveness in pulmonary artery stenting.
- A strong correlation exists between morphological and hemodynamic effectiveness, indicated by improved lung perfusion and reduced pressure gradients.
Background:
Percutaneous stenting for branch pulmonary artery stenosis is an established interventional choice in congenital heart disease. The apparent morphologic change in the vessel diameter often differs from the hemodynamic result.
Methods And Results:
We performed a subanalysis of the data from the Japanese Society of Pediatric Interventional Cardiology (JPIC) stent survey. The factors that may have contributed to morphologic effectiveness included reference vessel diameter (RVD), minimum lumen diameter (MLD) and percent diameter stenosis (%DS) and the relation between morphologic and hemodynamic effectiveness was evaluated in 206 lesions treated with stenting. We defined a "50% increase in MLD" as "morphologically effective", while "achievement of either a reduced pressure gradient greater than 50% or an increase of perfusion ratio to the affected side to the contralateral side greater than 20%" as "hemodynamically effective". Morphologic effectiveness was achieved in 84% of patients. Before stenting, %DS was significantly larger, while RVD was smaller in the "effective" group than in the "non-effective" group. The cutoff value for effective stenting was 51% for %DS and 14.7 mm for RVD before stenting. Hemodynamic effectiveness was obtained more often in the "morphologic effective" group.
Conclusions:
RVD and %DS were the 2 main contributors to acute morphologic effectiveness. There was a significant relationship between "morphologic effectiveness" and "hemodynamic effectiveness", judging from increased perfusion of the affected lung and/or decreased pressure gradient. (Circ J 2016; 80: 1852-1856).
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