Stent implantation for treatment of branch pulmonary artery and anastomosis stenosis in children with univentricular hearts / 中华胸心血管外科杂志

ABSTRACT

Objective Patients with single-ventricle physiology pose a wide variety of therapeutic challenges.Pulmonary artery or anastomosis stenosis in single-ventricle physiology will have only subtle hemodynamic derangements due to the lack of the pumping chamber to force blood across the stenosis.This study aimed to evaluate the feasibility and usefulness of the stent implantation for treatment of branch pulmonary artery and anastomosis stenosis in children with univentricular hearts.Methods Retrospective analysis of 8 implanted stents between March 2014 and January 2015 in Shanghai Children's Medical Center.Transthoracic echocardiography,chest roentgenography and electrocardiography were carried out as follow-up studies at the second day after operation and 1,3,6,12 months after the procedure.Results In all of eight patients (6 males and 2 females),5 cases were post-Glenn operation and 3 cases were post-Fontan operation.The median age was 6.6 years (range 4.0-8.5 years).The median weight was 19.5 kg(range 13.8-25.6 kg).9 stents were implanted successfully in all patient,6 in left pulmonary arteries,2 in right pulmonary arteries and 1 in anastomosis.All stents were placed in the target lesion without any complication.The diameter of the narrowed segment improved from (3.63 ± 2.06) mm to (7.89 ± 1.62) mm (P ＜ 0.01).During follow-up no other complication occurred except thrombus in one patient because of discontinuation anticoagulation.Conclusion Branch pulmonary arterial stenosis in single-ventricle patients may often be underestimated due to the low pressure venous system and/or the development of venovenous collaterals bypassing and decompressing the pulmonary circuit.In these patients,even mild stenosis should be treated aggressively,especially in the presence of pleural effusions,pericardial effusions,protein-losing enteropathy and low-output states.Stent implantation is an effective method of treating branch pulmonary artery stenosis.