Management of branch pulmonary artery stenosis: Balloon angioplasty or endovascular stenting

1. The surgical outcome of congenital heart diseases may be adversely affected by residual branch pulmonary artery stenosis, which is difficult to treat surgically. 2. The objective of the present study was to evaluate the effectiveness, safety and follow-up results of two transcatheter procedures. Balloon angioplasty and endovascular stenting, for treatment of branch pulmonary artery stenosis. 3. From December 1988 to March 1997, 22 children (group 1) underwent 30 balloon angioplasties and 12 children (group 2) underwent 14 endovascular stent implantations. The overall success rates for groups 1 and 2 were 67 (20/30) and 93% (13/14), respectively, with significant increases in vessel diameter (P<0.001, t-test, 29 d.f.; P = 0.0001, t-test, 12 d.f., respectively) and decreases in pressure gradient (P<0.0001, t-test, 29 d.f.; P = 0.001; t-test, 12 d.f., respectively). One death (3.3%) in group 1 was due to post-dilation reactive pulmonary hypertension. No mortality occurred in group 2 children, but two migrated stents required re-implantation of another stent. Mean follow-up periods were 28.2 and 26.3 months for groups 1 and 2, respectively. For group 1, no significant change in vessel diameter or pressure gradient was noted on recatheterization in 12 patients. Restenosis occurred in four of 16 (25%) initial successes. Balloon redilation in four vessels were all successful. For group 2 children, although vessel diameter remained unchanged, a significant increase in pressure gradient (P = 0.02; t-test, 11 d.f.) was noted on recatheterization. Balloon dilations on two narrowed stents caused by intimal proliferation showed only partial improvements. 4. In conclusion, both balloon angioplasty and endovascular stent implantation are effective and safe, with satisfactory intermediate-term results, for the treatment of branch pulmonary artery stenosis. Balloon angioplasty is the choice for initial treatment, whereas stent implantation, the long-term outcome of which remains to be determined, should be reserved for older children after repeated failures with balloon dilation.