Effectiveness and Safety of Percutaneous Transcatheter Implantation of Pulmonary Arterial Stent in Congenital Heart Disease

Abstract

Background and ObjectivesPulmonary arterial stenosis is a relatively common complication after corrective operation of congenital heart disease. Unilateral stenosis of pulmonary arteries could result in decrease perfusion of affected lung, pulmonary regurgitation, or elevation of right ventricular pressure. Eventually there are increasing risks of right ventricular failure, arrhythmia, or sudden death. However we have limited data of pulmonary arterial stent in paediatric population as the treatment of branch pulmonary stenosis. This study aimed at validating the effectiveness and investigating complications of pulmonary arterial stent implantation in a single institution during mid-term follow up period.Subjects and MethodsA total of 42 patients (50 stents) were implanted for treating branch pulmonary arterial stenosis. We used cardiac catheterization for comparing diameter after stent implantation directly and lung perfusion scan indirectly. We also investigated any adverse effect relating the procedure.ResultsPercent stenosis of stenotic lesions were decreased from 54.1±10.7% to 22.8±12.5% (p<0.001) and degree of decrement in affected lung perfusion was declined from 22.7±8.0% to 10.3±9.0% (p<0.001) immediately and lasts during mid-term follow up period. Complication rate relating the procedure was 12% (6 out of 12) and there was no mortality case.ConclusionThis series showed immediate and short term effectiveness of pulmonary arterial stent in congenital heart defects. We concluded that percutaneous transcatheter implantation of pulmonary arterial stent was safe and effective during short and mid-term follow up period.

The effects of percutaneous branch pulmonary artery interventions on exercise capacity, lung perfusion, and right ventricular function in biventricular CHD: a systematic review

“…This might be explained by the increase in blood vessel diameter and is substantiated by studies that show the effectiveness of interventions for branch pulmonary artery stenosis on dilating the blood vessel. [15][16][17] Fogelman et al found no significant improvement for right pulmonary artery flow after the percutaneous intervention, which might be a result of the small sample size (n = 4). Overall, there is a general trend towards improved lung perfusion after a percutaneous intervention in the & p-value between lung perfusion post intervention and follow-up (both 6 months and 1 year) not significant (p > 0.05).…”

“…Percutaneous balloon angioplasty and stent implantation in branch pulmonary artery stenosis have been proven safe and effective in patients with CHD. [15][16][17] However, the (long-term) outcomes on exercise capacity, right ventricular function, and lung perfusion remain fairly unknown. Therefore, the aim of this review was to describe the (longterm) effects of percutaneous branch pulmonary artery interventions on exercise capacity, right ventricular function, and lung perfusion in biventricular CHD.…”

The outcome of percutaneous stent implantation in congenital heart disease: experience of a single institute

“…However, in Korea, only a few reports about stent implantation in patients with CHD have been published, and they included only immediate or short-term follow-up in patients with PAS. 4 5) The purpose of this study was to evaluate the safety and efficacy of intravascular stent implantation in various types of CHD, and to assess the improvement in immediate and midterm outcomes based on our experience in a single institute.…”

Pulmonary Artery Stents-Still "Off Label"

“…In this issue of Korean Circulation Journal, Ko et al 1) report on the effectiveness and safety of percutaneous implantation of pulmonary arterial stents in congenital heart disease between 1999 and 2010 in one institute. Since Dr. Mullins recognized the potential for stents to treat pulmonary arterial stenosis effectively which were compared to the surgical methods, many reports about these experiences have been reported.…”

“…Most of the studies demonstrated the effectiveness of pulmonary arterial stenting by increasing pulmonary artery size, reducing pressure gradients, decreasing right ventricular pressure and improving the disparity in pulmonary arterial blood flow. 2 - 5) However, there are few reports with long-term follow-up data in a large population of patients, especially no multicenter, randomized controlled studies as Ko et al 1) noted. Therefore, in spite of the efforts of many doctors, the use of stents to treat pulmonary arterial stenosis is still considered "off label"-i.e., not approved by the Food and Drug Administration, even though the investigational device exemption (IDE) was obtained by Dr. Mullins' efforts.…”