Long-Term Outcomes After Surgical Pulmonary Arterioplasty and Risk Factors for Reintervention

Abstract

Long-term reintervention for recurrent PA stenosis after patch arterioplasty is common. Patients with bilateral PA stenosis or age younger than 30 days at the time of the index pulmonary arterioplasty are at higher risk for reintervention. These patients may benefit from frequent monitoring or novel approaches to repair.

Pulmonary artery and lung parenchymal growth following early versus delayed stent interventions in a swine pulmonary artery stenosis model

“…PAS is associated with many forms of congenital heart disease (CHD) and is a frequent indication for intervention. [10][11][12][13][14][15][16][17] Operations to address PAS in infants and children during the alveolar and PA developmental phase have varying outcomes and restenosis rates [18][19][20] and in several centers first line therapy for PAS is accomplished using the catheter-based techniques of angioplasty and intravascular stenting.…”

Novel arterioplasty of severe left pulmonary artery stenosis using native main pulmonary artery

“…3 However, all of these techniques have a high rate of restenosis which is largely attributed to the extension of ductal tissue into the branch PAs, scarring, fibrosis, and cicatrization of the autologous pericardium. 2,4,5 Our patient had an unusual presentation. Though the pulmonary arterial supply was sparse, the size of both the branch PAs at the hilum was generous.…”

“…These include enlargement with autologous pericardium (fresh/pretreated), bovine pericardium, Gore‐Tex patch/tube, Dacron grafts, homografts, and resection with direct end to end anastomosis 3 . However, all of these techniques have a high rate of restenosis which is largely attributed to the extension of ductal tissue into the branch PAs, scarring, fibrosis, and cicatrization of the autologous pericardium 2,4,5 …”

“…1 Surgical repair of branch PA stenosis especially the left pulmonary artery (LPA), regardless of the technique employed, carries a significant incidence of recurrence due to the residual ductal tissue and highlights the importance of removing it from the branch PAs which can sometimes compromise their length. [1][2][3][4][5] This also makes direct tension-free anastomosis difficult to accomplish. We describe a novel way of enlarging the LPA by employing native, autologous pulmonary arterial tissue while excluding all ductal tissue from the anastomotic stoma.…”

“…It is presumed to occur due to extension of ductal tissue into the wall of the PAs 1 . Surgical repair of branch PA stenosis especially the left pulmonary artery (LPA), regardless of the technique employed, carries a significant incidence of recurrence due to the residual ductal tissue and highlights the importance of removing it from the branch PAs which can sometimes compromise their length 1–5 . This also makes direct tension‐free anastomosis difficult to accomplish.…”