Cutting balloon angioplasty for children with small‐vessel pulmonary artery stenoses

Abstract

Patients with complex congenital heart disease may have pulmonary artery stenoses that are either congenital or associated with scarring following surgical procedures. This study evaluates cutting balloon angioplasty for small-vessel pulmonary artery stenoses resistant to standard balloon angioplasty. Between October 1998 and December 1999, patients were enrolled in an FDA-approved compassionate-use protocol. During four catheterizations, there were seven lesions found resistant to standard balloon angioplasty (mean lesion diameter was unchanged: 1.8 mm +/- 0.8 mm to 1.9 +/- 0.8 mm). A cutting balloon was inflated twice in each of these lesions. Standard balloon angioplasty was then repeated. Final mean lesion diameter was increased significantly (1.9 mm +/- 0.8 mm to 3.8 +/- 1.3 mm; P <or= 0.01). Follow-up catheterizations performed a median of 14 months later showed only slight decrease in mean lesion diameter (3.2 +/- 1.2 mm), still significantly greater than initial mean lesion diameter (P < 0.03). In conclusion, cutting balloon angioplasty for pulmonary artery stenoses resistant to standard balloon angioplasty improves the immediate and intermediate term results of angioplasty for these lesions.

Randomized Trial of Cutting Balloon Compared With High-Pressure Angioplasty for the Treatment of Resistant Pulmonary Artery Stenosis

“…These clinical benefits were difficult to demonstrate as convincingly in prior retrospective reviews. 1,[5][6][7][11][12][13] …”

“…11 (15) Time to hospital discharge (nϭ73), d* 1 ͓1-1͔ (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) Values are median ͓interquartile͔ (range) when appropriate. *For 2 patients, the case was staged and the patient received angioplasty treatment in 1 lung followed by treatment on the other side the next day.…”

“…Indeed, in these early studies, CB was only used after failure of high-pressure angioplasty with pressures of 15 to 22 atm. 11,12 Such lesions were frequently "undilatable" with the HPBs available then and did not respond well to stenting because the stent could not be completely expanded. In the initial application of CB to treat PA stenotic lesions that were resistant to HPBs, the percent lumen gain was significantly greater, and this was sustained at follow-up angiography.…”

Pathophysiology of Congenital Heart Disease in the Adult, Part II

“…29 Current techniques have been best applied to isolated lesions and involve balloon angioplasty, stent angioplasty, and the use of cutting balloons when standard balloons have failed. [31][32][33][34] Outcomes in patients with diffuse pulmonary obstructions (Williams, Noonan, and Alagille syndromes and rubella) have been generally poor. 35 This can be attributed to 2 factors.…”

Simulation of the Thermal and Mechanical Effects of a Planar Rectangular High Intensity Ultrasound Transducer to Be Used for Destroying Atherosclerotic Plaque

“…In advanced cases, atherosclerosis treatment may require special surgical procedures such as Balloon Angioplasty [9][10][11][12], Balloon Angioplasty and Stenting [13][14][15], Cutting Balloon [16][17][18][19][20][21], Atherectomy [22,23], Surgical Bypass [24,25] and Endarterectomy [26,27] to open an artery and improve blood flow.…”