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Branch pulmonary artery stent angioplasty in infants less than 10 kg
Brooke Liu Cao1, Jonathan Mervis1,2, Paul Adams2
1The University of Sydney, Australia.
Insights
Branch pulmonary artery stenting is effective and safe for infants under 10kg, though reintervention is common. This procedure can relieve early post-operative hemodynamic compromise in critical cases.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Branch pulmonary artery stenting is a recognized treatment for pulmonary artery stenosis in older patients.
- Its application and outcomes in infants, particularly those weighing less than 10kg, are less established.
- This study details the experience of performing branch pulmonary artery stenting in this specific infant population.
Purpose of the Study:
- To evaluate the efficacy and safety of branch pulmonary artery stenting in infants weighing less than 10kg.
- To assess the technical success, complications, and need for reintervention in this cohort.
- To determine the impact of urgent stenting on hemodynamic compromise.
Main Methods:
- A retrospective chart review was conducted for infants under 10kg who underwent branch pulmonary artery stenting between 2010 and 2020.
- Pre- and post-procedural angiograms were analyzed to measure changes in pulmonary artery diameter.
- Technical success was defined as a greater than 50% increase in pulmonary artery diameter; complications and reinterventions were recorded.
Main Results:
- Forty-one infants (mean weight 5.9kg) underwent 43 stenting procedures, with the majority being transcatheter implantations.
- Significant increases in both left and right pulmonary artery diameters were observed post-stenting (p < 0.01).
- The study reported 2 minor and 1 major complication, with no procedural mortality, but a 49% rate of reintervention within 13.6 months.
Conclusions:
- Branch pulmonary artery stenting is an effective and safe intervention for infants under 10kg with pulmonary artery stenosis.
- High rates of reintervention should be anticipated in this population.
- Urgent stenting can effectively alleviate early post-operative hemodynamic instability.
Background:
Branch pulmonary artery (PA) Stenting is an established strategy for PA stenosis in older children and adults. Its use in infants is less well established. We describe our experience of branch PA Stenting in infants <10 kg.
Method:
Retrospective chart review of infants <10 kg who underwent PA Stenting at The Children's Hospital, Westmead between 2010 and 2020. Pre and post-procedural angiograms were reviewed to determine PA size. Technical procedural success was defined as >50% increase in PA diameter. Procedural complications and need for PA re-intervention were ascertained.
Results:
Forty-one children (age 7.6 months, IQR 2.4-9.8 months, weight 5.9 ± 2.2 kg) had 43 primary Stent implantations (10/43 intraoperative versus 33/43 transcatheter; left pulmonary artery [LPA] 25/43, right pulmonary artery [RPA] 8/43 and bilateral 10/43). Diagnoses were tetralogy of Fallot (27%), hypoplastic left heart syndrome (24%), truncus arteriosus (12%), transposition of the great arteries (7%), other single ventricle (10%) and other biventricular (20%). 40/41 (98%) had undergone a cardiac intervention in the preceding 31 days, [IQR 1-181], with 17/41 having prior branch PA intervention. 14/41 patients had urgent Stenting. There were 2 minor and 1 major complications with no procedural mortality. LPA (LPApre 2.3 ± 1.0 × 2.2 ± 1.2 mm versus LPApost 5.2 ± 1.3 × 5.0 ± 1.7 mm, p < 0.01) and RPA (RPApre 2.5 ± 0.8 × 1.9 ± 0.8 mm versus RPApost 4.9 ± 1.0 × 4.1 ± 1.0 mm, p < 0.01) calibre increased post Stenting. 20/41 required branch PA reintervention (time to reintervention 13.6 months [IQR 8.2-29.3].
Conclusions:
Branch PA Stenting is effective and safe in infants <10 kg with expected high rates of reintervention. Urgent PA Stenting provides relief of early post-operative haemodynamic compromise.
