Medium and Long-Term Outcomes After Bilateral Pulmonary Artery Stenting in Children and Adults With Congenital Heart Disease

Abstract

Percutaneous stenting of branch pulmonary arteries (PAs) has become an important interventional therapy in the complete management of congenital heart disease. Few data exist on long-term outcomes for patients requiring placement of bilateral stents. This study aimed to determine the medium- to long-term outcomes after bilateral stenting of branch PAs in patients with congenital heart disease. A retrospective study analyzed all procedural and follow-up data on patients undergoing bilateral PA stenting during a single procedure. From October 2001 to May 2012, 26 patients underwent bilateral PA stenting (total of 62 stents). The mean age of these patients was 9.5 ± 12 years, and their mean weight was 27 ± 19 kg. The mean procedural time was 191 ± 67 min, and the mean fluoroscopy time was 50 ± 29 min. The mean gradient across the right pulmonary artery decreased from 35 ± 22 to 11 ± 12 mmHg (p < 0.001). The left pulmonary artery gradient decreased from 32 ± 17 to 10 ± 12 mmHg (p < 0.001), and the right ventricle to descending aorta pressure ratio decreased from 71 ± 18 % to 46 ± 13 % (p < 0.001). Intraprocedural adverse events were encountered in four patients (1 small PA dissection, 2 intraprocedural arrhythmias, and 1 first-degree burn on the thigh). The mean follow-up period was 41 ± 23 months. Two deaths occurred. Further interventions were required for 12 patients. Bilateral PA stenting is effective and safe, with an instantaneous significant decrease in pressure gradients. The need for reintervention is common, so continued follow-up assessment is warranted.

Pulmonary artery stents in the recent era

“…Our study showed an overall 17% procedural complication rate of which 12% are in the major category. Review of the literature suggests pulmonary artery stent complication rates ranging from 10% to 33% . However, given the diversity of patients, heterogeneity of pulmonary artery stenoses and changing technology and stent implantation techniques over time, it is difficult to compare complications between studies.…”

Risk factors and preventive measures of cerebral hyperperfusion syndrome after carotid artery interventional therapy

“…The pathological changes caused by carotid artery stenosis are closely related to those observed following ischemic stroke ( 2 ). Therefore, using carotid artery stenting (CAS) treatment for extracranial carotid artery stenosis and the prevention of ischemic stroke is important for reducing the threat of cerebrovascular diseases ( 3 , 4 ). However, this operation may lead to CHS.…”

Rapid prototyped sutureless anastomosis device from self‐curing silk bio‐ink

“…Devices such as microclips, ring staplers, and magnets have been used to improve sutureless anastomosis but are composed of nondegradable materials. Permanent vascular implants can induce chronic trauma and raises concerns for growing children or adolescents suffering from congenital disease or traumatic vascular injury . For these reasons, a gamut bioresorbable strategies are being developed for vascular implants .…”

“…Permanent vascular implants can induce chronic trauma and raises concerns for growing children or adolescents suffering from congenital disease or traumatic vascular injury. 9 For these reasons, a gamut bioresorbable strategies are being developed for vascular implants. 10,11 Current experimental bioresorbable devices exhibit relatively weak anastomotic pull-out strength compared with permanent alternatives.…”