Coarctation of the Left Pulmonary Artery: Effects on the Pulmonary Vasculature of Infants

Zevallos-Giampietri, E. A.; Thelmo, William; Anderson, V. M.

doi:10.1007/s002469900204

Cited by 14 publications

(6 citation statements)

References 26 publications

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“…However, in eight other patients in whom two or three stents were placed in main, left, or right pulmonary artery stenoses, intimal hyperplasia did not occur. An explanation for the presence intimal hyperplasia in some cases but not others could be the presence of residual duct tissue, 14 which provokes intimal proliferation. Severe intimal hyperplasia after stenting of a right pulmonary artery stenosis was described by Ing and colleagues in a previous report.…”

Section: Discussionmentioning

confidence: 99%

Various reasons for repeat dilatation of stented pulmonary arteries in paediatric patients

Schneider

2002

Heart

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Objective: To evaluate the reasons for repeat intervention in patients treated with balloon expandable stents for pulmonary artery stenoses, with particular analysis of the time intervals between interventions. Design: A retrospective observational study. Setting: A single paediatric cardiology centre. Patients: 38 patients, mean age 6.9 years, range 6 days to 34 years (one adult patient); mean weight 19.7 kg, range 2.5-75 kg. Intervention: Implantation of balloon expandable stents in 46 cases of main pulmonary artery stenosis, right pulmonary artery stenosis, left pulmonary artery stenosis, or right ventricle to pulmonary artery conduits. Main outcome measures: Adaptation of stent diameter to patient growth; development of pulmonary arteries; pressure gradient in the right ventricle. Results: 56 stents were implanted in 46 lesions. During a mean follow up time of 2.2 years, 40 repeat dilatations were performed on 28 of 42 reinvestigated stents. A second repeat dilatation was performed on eight stents, and a third on four stents. The mean time period between implantation and repeat dilatations was 15.5 months. Conclusions: Repeat dilatation of stented pulmonary arteries was done mainly to adapt the stent diameter to the patient's growth. However, repeat dilatations were also performed to relieve stent obstruction caused by intimal proliferation (17.5%), or to overcome progressive external compression (25%). While most repeat interventions in adult patients are for intimal hyperplasia, in paediatric patients they are needed for a variety of reasons. S tent implantation has become the non-surgical treatment of choice [1][2][3][4] to overcome the immediate and late results of balloon dilatation of pulmonary artery lesions in paediatric patients.5-7 Stent implantation is carried out on postoperative or native lesions, and most stents are implanted for life. The limited lifespan of bioprosthetic right ventricle to pulmonary artery conduits caused by progressive lumen obstruction can also be treated by transcatheter stent implantation to postpone the need for reoperation.Palliative stenting is possible in neonates and infants with complex cardiac malformations who are at high risk from surgical intervention. For example, stenting of the central pulmonary artery in small patients with pulmonary atresia after interventional radiofrequency assisted valvuloplasty of the atretic valve is an alternative to a palliative aortopulmonary shunt operation. In paediatric patients, implanted stents require observation and repeat dilatation as the child grows 9 or when there is intimal proliferation or external compression from related structures. 8 Our aim in this study was to evaluate the different reasons for repeat dilatation of balloon expandable stents in pulmonary artery stenoses, with particular reference to the time interval between the procedures. METHODS Patient populationThirty eight paediatric patients with 46 pulmonary artery stenoses or obstructions underwent cardiac catheterisation and insertion of a total of 56 ball...

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Section: Discussionmentioning

confidence: 99%

Various reasons for repeat dilatation of stented pulmonary arteries in paediatric patients

Schneider

2002

Heart

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“…They are the most common cause of developmental anomalies and non-infectious infant mortalities (9). A large number of CHD patients exhibit diffuse or focal obstructions in their pulmonary arteries resulting from an abnormal extension of ductal tissue (42), postoperative damage after surgical repair of other CHD lesions as in the case of tetralogy of Fallot (24), or genetic disorders such as Alagille or Williams syndromes (8,19). The long-term effects of pulmonary artery stenosis, whether native or postoperative, are poorly understood and are only based on anecdotal evidence.…”

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confidence: 99%

Chronic effects of pulmonary artery stenosis on hemodynamic and structural development of the lungs

Razavi¹,

Stewart

Xu³

et al. 2013

American Journal of Physiology-Lung Cellular and Molecular Phys

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Pulmonary artery (PA) stenosis is a difficult obstructive defect to manage since clinicians cannot know a priori which obstructions to treat and when. Prognosis of PA stenosis and its chronic effects on lung development are poorly understood. This study aimed to characterize the hemodynamic and structural effects of PA stenosis during development. Fourteen male Sprague-Dawley rats underwent left PA (LPA) banding at age 21 days, and 13 underwent sham operation. Hemodynamic and structural impacts were studied longitudinally at 20, 36, 52, 100, and 160 days. Chronic LPA banding resulted in a significant reduction in LPA flow (P < 0.0001) and size of both proximal LPA (P < 0.0001) and distal LPA (P < 0.01), as well as a significant increase in flow and size of the right PA (P < 0.05) throughout development. Flows and sizes adapted such that normal levels of wall shear were restored after banding. At 160 days, LPA banding resulted in a significant decrease in left lung volume and an increase in right lung volume but no significant differences in total lung volume. There was an elevation of proximal LPA pressure as well as right ventricular hypertrophy in the banded animals. The banded lung exhibited arterial disorganization, loss of vessels, and enlargement of its bronchial arteries, whereas the contralateral lung showed signs of vascular pathology. There are consequences on development of both lungs in the presence of an LPA stenosis at young age. These results suggest that early intervention may be necessary to optimize left lung growth and minimize right lung vascular pathology.

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“…The second hypothesis arises from histological studies of Gittenberger-de Groot et al 1718 and Zevallas-Giampietri 19…”

Section: Discussionmentioning

confidence: 99%

Closure of the ductus arteriosus and development of pulmonary branch stenosis in babies of less than 32 weeks gestation

Arlettaz

Archer

Wilkinson

2001

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Aims-To define how often transient pulmonary branch stenosis (PBS) develops after closure of a patent ductus arteriosus (PDA) in babies born at less than 32 weeks gestation; to describe the natural history of PBS and the relation between PBS and a cardiac murmur. Methods-Fifty three preterm infants born at a gestational age less than 32 weeks and who had PDA diagnosed on echocardiography were recruited. An echocardiogram was performed on alternate days until the ductus arteriosus closed. If PBS was diagnosed, the baby was followed up until PBS resolved. Results-In 59%, PBS developed in one or both branches after closure of the PDA. In 21%, both pulmonary branches were affected. In 79%, the left pulmonary artery alone was involved but the right side was never aVected alone. PBS had resolved in 74% by the time the infants reached 40 weeks, in 95% at a corrected age of 6 weeks, and in 100% at a corrected age of 3 months. There is a better correlation between a cardiac murmur and PBS than between a murmur and PDA. Conclusions-PBS in preterm infants is usually not present at birth but develops after closure of a PDA. PBS resolves by a corrected age of 3 months. The presence of a murmur after closure of a PDA is usually related to PBS and not to reopening of the ductus arteriosus.

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Coarctation of the Left Pulmonary Artery: Effects on the Pulmonary Vasculature of Infants

Cited by 14 publications

References 26 publications

Various reasons for repeat dilatation of stented pulmonary arteries in paediatric patients

Various reasons for repeat dilatation of stented pulmonary arteries in paediatric patients

Chronic effects of pulmonary artery stenosis on hemodynamic and structural development of the lungs

Closure of the ductus arteriosus and development of pulmonary branch stenosis in babies of less than 32 weeks gestation

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