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Stent implantation for relief of pulmonary artery stenosis: immediate and short-term results
Z M Hijazi1, F al-Fadley, R L Geggel
1Department of Pediatrics, Floating Hospital for Children, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Insights
Stent implantation effectively relieved pulmonary artery stenosis (PAS), significantly reducing pressure gradients and increasing vessel diameter. While complications occurred, the procedure demonstrated safety and efficacy in improving patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Pulmonary artery stenosis (PAS) is a critical condition often requiring intervention.
- Stent implantation is a potential treatment for relieving PAS.
Purpose of the Study:
- To evaluate the immediate and short-term outcomes of pulmonary artery stent implantation.
- To assess the safety and efficacy of this intervention for PAS.
Main Methods:
- Thirty-seven patients underwent attempted stent implantation for PAS.
- Successful stent implantation was achieved in 36 patients, with 55 stents placed.
- Hemodynamic and dimensional changes were measured pre- and post-procedure.
Main Results:
- Peak systolic gradient decreased from 43 mmHg to 13 mmHg (P < 0.001).
- Narrowest segment diameter increased from 4.8 mm to 10.5 mm (P < 0.001).
- Complications included balloon rupture, stent migration, and one death; however, two cases of neointimal proliferation were successfully redilated.
Conclusions:
- Stent implantation is a generally safe and effective method for relieving pulmonary artery stenosis.
- The procedure leads to significant hemodynamic and anatomical improvements in patients with PAS.
Abstract:
Our objective was to assess the immediate and short-term results of stent implantation to relieve pulmonary artery stenosis (PAS). Thirty-seven patients underwent an attempt at stent implantation at a median age of 7.0 years (range, 0.8-31.4 years) and a median weight of 20.5 kg (range, 7.4-85 kg). Twenty-two patients had previous tetralogy of Fallot repair. A total of 55 stents were implanted successfully in 36 patients. The peak systolic gradient across the stenotic segment decreased from a mean of 43 +/- 20.4 mmHg prestent to 13 +/- 13.9 mmHg (P < 0.001) poststent. The diameter of the narrowest segment increased from a mean of 4.8 +/- 1.6 mm to 10.5 +/- 2.6 mm (P < 0.001). The right ventricular-to-aortic mean systolic pressure ratio decreased from 0.74 +/- 0.2 to 0.52 +/- 0.19 (P < 0.001). Complications included balloon rupture prior to full stent expansion in 4 patients (in 2 patients the stent was positioned in the superior vena cava, and in 2 in the inferior vena cava), distal migration of a stent which was successfully retrieved at surgery 1 mo later in 1 patient, and tethering of the stent to the balloon requiring surgical removal in 1 patient. One patient died several hours after stent placement. Sixteen patients underwent repeat catheterization at a mean follow-up interval of 0.9 +/- 0.5 years (range, 0.2-2.0 years). The mean gradient across the stent for these 16 patients was 26.7 +/- 19.8 mmHg, and there was no change in the mean diameter (9.4 +/- 3.2 mm). Two patients developed stenosis related to neointimal proliferation at the stent site which was redilated successfully. In conclusion, stent implantation is generally safe and effective in relieving PAS.