Main branches pulmonary artery stenting in congenital heart diseases: a case series

Branch pulmonary artery (PA) stenosis is a common complication in congenital heart disease (CHD) that can result in unequal pulmonary perfusion, cyanosis, and increased ventricular workload. Although surgical repair remains an option, pulmonary artery stenting has emerged as a less invasive and effective alternative for restoring vessel patency.

This single-center retrospective study included 18 pediatric patients (median age 5.4 years, range 3 months-17 years) who underwent PA stenting for branch stenosis associated with complex CHD. Patient demographics, procedural characteristics, complications, and follow-up outcomes were analyzed.

A total of 19 stents were successfully implanted; 10 in the left PA, 7 in the right PA, and one case of bilateral stenting. The mean pre-procedural oxygen saturation improved from 78.1% ± 12.5 to 91.6% ± 7.3 during follow-up. Procedural success was achieved in all cases. Five complications were recorded, including one case of stent dislodgement requiring surgical retrieval and one case of inadequate stent expansion due to over-compliant pulmonary arteries. Three deaths occurred, all attributed to underlying clinical deterioration rather than the procedure itself. No instances of vascular rupture or pericardial tamponade were observed. Most surviving patients demonstrated sustained improvement in oxygenation and progressed to definitive surgical repair or Fontan completion.

Pulmonary artery stenting is a safe and effective intervention for managing branch PA stenosis in complex pediatric CHD, providing significant hemodynamic and clinical benefits with an acceptable complication profile. Careful pre-procedural imaging, appropriate stent selection, and meticulous deployment technique are essential to prevent complications such as dislodgement or incomplete expansion, ensuring durable long-term outcomes.