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Pulmonary artery stenosis following aortopulmonary anastomoses
Insights
Banding Potts or Waterston aortopulmonary shunts effectively limited anastomosis growth and reduced pulmonary artery stenosis. Unbanded shunts showed higher rates of stenosis and elevated pulmonary artery pressures, discouraging their use.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Imaging
Background:
- Potts and Waterston aortopulmonary shunts are surgical procedures used to treat congenital heart defects.
- The growth of these shunts can lead to complications such as pulmonary artery stenosis.
- Shunt banding is a technique to control shunt size and prevent excessive growth.
Purpose of the Study:
- To evaluate the long-term effects of banding on Potts and Waterston aortopulmonary shunts.
- To compare the incidence of shunt growth and pulmonary artery stenosis between banded and unbanded shunts.
- To assess the impact of shunt type and banding on pulmonary artery pressures.
Main Methods:
- Retrospective analysis of angiographic data from 95 patients (1965-1979).
- 52 shunts were banded to limit growth; 43 were unbanded.
- Internal diameter of shunts measured during cardiac defect repair.
- Pulmonary artery pressures assessed in 77 children.
Main Results:
- Banding effectively limited shunt growth in 94% of cases, compared to 31% for unbanded shunts (p=0.05).
- Pulmonary artery stenosis occurred in 50% of banded shunts versus 31% of unbanded shunts (p=0.07).
- Unbanded shunts had a 60% incidence of pulmonary artery stenosis and higher rates of elevated pulmonary artery pressures.
Conclusions:
- Shunt banding is effective in controlling the growth of Potts and Waterston aortopulmonary anastomoses.
- Unbanded shunts are associated with a higher risk of pulmonary artery stenosis and elevated pressures.
- The findings suggest caution in using unbanded Potts or Waterston shunts if alternative procedures are available.
Abstract:
From 1965 to 1979, 44 patients with Potts and 50 with Waterston aortopulmonary anastomoses were studied angiographically. Fifty-two of the 95 shunts had been banded to limit growth of the anastomosis. Later the internal diameter of the anastomosis was measured in 34 children when the cardiac defect was repaired. On those with late measurements, growth was limited effectively in 17 of the 18 (94%) shunts that had been banded, whereas five of the 16 (31%) unbanded anastomoses grew to more than 6.5 mm internal diameter (p = 0.05). The difference in incidence of moderate or severe stenosis of the pulmonary artery near or at the anastomosis nearly reached a significant level (p = 0.07), occurring in 50% of children with banded shunts in comparison with 31% of children with unbanded shunts. Mean pulmonary artery pressures were obtained in 77 children, 36 with potts and 41 with Waterston shunts. Six of 43 with a banded anastomosis had a mean pulmonary artery pressure above 30 mm Hg, the highest being 43 mm Hg. Seven of 34 children with an unbanded anastomosis had a mean pulmonary artery pressure of 30 mm Hg or more, and in three the pressures were over 50mm Hg. In unbanded Potts or Waterston shunts the incidence of pulmonary artery stenosis was 60%. This high incidence discourages the use of these aortopulmonary anastomoses if other shunts can be constructed safely and effectively.