TRANSCATHETER IMPLANTATION OF STENTS FOR POSTOPERATIVE RESIDUAL PERIPHERAL PULMONARY STENOSIS

Hwang BT^{1, 2}, Lee PC¹, Fu YC³, Jan SL³, Chiu PS¹, Tsai MC¹, Kao CC¹, Weng ZC¹, Lu JH¹, Meng CCL¹, Lee AJ¹

¹ Taipei Veterans General Hospital Taipei, Chinese Taipei

² National Yang-Ming University

³ Taichung Veterans General Hospital, Taichung, Chinese Taipei

Objective: To relief the significant peripheral pulmonary artery stenosis (PPAS), a prospective study of transcatheter implantation of stents on five patients with PPAS. The safety and efficacy of balloon-expandable stents for PPAS is evaluated and analyzed.

Methods: From June 1998 to Dec. 2000, a total of 13 cases with simple or complex PPAS were enrolled for study. Eight of them received surgical correction after the complete study and evaluation. The other 5 patients underwent transcatheter implantation of stent, because the surgery might be with a higher risk of mortality or morbidity. They are tetrology of Fallot (TOF), s/p OP in 4 and transposition of great vessels (TGV), s/p Jatene in 1. Their ages ranged from 6.4 to 17.3 (1.0��5.8) years and body weights ranged from 17.3 to 72.5 (39.0��25.6) kg. After the complete physical examination and routine studies were obtained, the cardiac catheterization to evaluate the location and severity of pulmonary artery stenosis were performed. After balloon angioplastry, a P308 Palmaz stent which mounted on the balloon catheter was advanced through the long sheath to the narrowest site, then the balloon was inflated to dilate the stent and narrowing peripheral pulmonary artery. The diameter and pressure gradient across the stenosis were measured before and after stent implantation. A follow-up cardiac catheterization to evaluate the efficacy was performed one year later.

Results: Total of 9 stents were implanted on these 5 patients. The pressure gradient across the stenosis dropped from 32.6��10.4 to 11.2��5.1 mmHg (-65.5%)(p<0.01), and the narrowest diameter increased from 7.7��3.7 to 11.5��3.1 mm (+58.4%) (p<0.01). Only a young male with TOF, s/p OP had a residual gradient of 20 mmHg between main and left pulmonary artery one year late. Re-dilated with implantation of one more stent dropped the pressure gradient down to 12 mmHg. There were no immediate or late complication.

Conclusion: Transcatheter implantation of the stent for treatment of peripheral pulmonary artery stenosis in patients with post-operative congenital heart disease is a safe and effect procedure. Since child is gowing with age, long-term follow-up to evaluate the effects and possible problem is mondator.

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