Background: Branch pulmonary artery (PA) obstruction during and after completion of staged palliation for children with single ventricle repair is a relatively common problem with significant hemodynamic consequence. Percutaneous dilation with stents provides a viable therapeutic option. We present our 15 year experience with PA stent implantation in univentricular circulations.
Methods: Retrospective review of all clinic charts cath reports and cineangiography images from consecutive patients with single ventricle physiology that underwent stent implantation in our institution between the years 1999-2014. All patient demographic data, congenital heart defects and data on stent implantation, including measurements of the pulmonary arteries were recorded. All follow-up imaging was reviewed for patency and dimensions of the stent and adjacent vessel.
Results: Thirty six stents were implanted in the pulmonary arteries of 29 patients [16M,13F] of median age 5.5yrs [1.6-19.7]. 15 patients had stent implanted after Fontan completion, 14 after a bidirectional Glenn shunt and 1 patient with a modified Blalock-Taussig shunt (MBT) shunt. The majority of the stents were implanted in the left PA [91%] and the stent was dilated to the diameter of the distal main artery. The PA diameter increased from 5.2±2.2mm to 11±2.1mm [p<0.01]. There were no complications directly related to the procedure. Angiographic follow-up was available on 25 stents in 20 patients at median follow up 4.1yrs [0.4 -11]. During that period 18 stents were redilated. The mean stent diameter on follow up was 10.4±1.4mm, similar to the 11±2.1mm mean diameter at initial implantation (p>0.05) and to the 11±2mm mean diameter of the contralateral PA (p>0.05) .
Conclusion: Stent implantation for relief of branch pulmonary arteries obstructions in children undergoing staged palliation for univentricular hearts is safe and effective with very good intermediate results. Stents may need redilation to accommodate for growth or ingrowth.
