Management of Post-operative Pulmonary Artery Stenosis in Tetralogy of Fallot

ABSTRACT

PURPOSE: Pulmonary artery stenosis is a common finding in post-operative tetralogy of Fallot (TOF), and it is one of the most frequent indication of reoperation. The objective of this study was to determine the procedural success rate of balloon angioplasty(BAP), endovascular stent, and reoperation for pulmonary artery stenosis in terms of its clinical impact on the subsequent management of these patients. METHODS: Hemodynamic and angiographic data from 71 patients who underwent balloon dilatation, stent implantation and reoperation for pulmonary artery stenosis between Jan. 1984 and Nov. 1999 were reviewed, retrospectively. The 71 patients had 94 vessels dilated by BAP. Criteria of BAP and stent implantation for success were > or =50% increase in vessel diameter or > or =20% decrease in right ventricular to aortic pressure ratio. Stent implantation was attempted in 16 patients and reoperation was performed in 11 patients. RESULTS: Of the 94 balloon angioplasty, 70(74%) were successfully dilated. In 16 patients, balloon angioplasty was ineffective for stenosis relief, thus endovascular stent implantation was attempted. All cases of endovascular stent were successfully implanted except one case which was dislodged. Reoperation was attempted in 11 patients in who balloon angioplasty failed or had ineffective results. CONCLUSION: BAP is beneficial for pulmonary artery stenosis. Left pulmonary artery kinking should be suspected at long-term follow up after tetralogy repair in patients with significant pulmonary regurgitation and right-side dilatation. Stent implantation or reoperation is considered when aneurysmal dilatation of pulmonary trunk, kinking components are suspected.