Early results and follow-up of balloon angioplasty for branch pulmonary artery stenoses

Abstract

Two hundred eighteen balloon angioplasty procedures were performed in 135 patients with branch pulmonary artery stenoses from June 1984 to February 1989. Arteries were dilated in patients with tetralogy of Fallot (n = 49), tetralogy of Fallot/pulmonary atresia (n = 64), isolated peripheral pulmonary artery stenoses (n = 58) and "other" lesions (the majority had truncus arteriosus or single ventricle and surgically induced pulmonary artery stenoses (n = 47). Mean age at dilation was 6.6 +/- 6.3 years (range 1 month to 38.5 years). The mean diameter of the lesion increased from 3.8 +/- 1.7 to 5.5 +/- 2.1 mm with dilation (p = 0.001). The overall success rate was 58% (127 of 218 dilations), assessed by the following criteria: an increase greater than or equal to 50% of predilation diameter, an increase greater than 20% in flow to the affected lung or a decrease greater than 20% in systolic right ventricular to aortic pressure ratio. Success did not correlate with patient age. Mean balloon to artery ratio was higher in successful (4.2) than in failed (3.0) angioplasty procedures (p = 0.0001). There were four early deaths: two of the patients had pulmonary artery rupture with angioplasty performed less than 1 month after pulmonary artery surgery. An aneurysm occurred in 11 arteries and transient pulmonary edema in four patients. At angiography performed a mean of 10 months (range 1 to 54) after dilation, the mean diameter of 57 arteries was unchanged (5.5 versus 5.4 mm). However, 5 of 32 initially successfully dilated vessels had returned to predilation size as a result of restenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Implantable Sensor System for Remote Detection of a Restenosis Condition

“…4, worse ISR conditions, reflected in higher R 1 and R 2 values, increase the pressure gradient along the longitudinal axis of the e-stent, as well as the mean output voltage of the system. The simulation results show a similar behaviour to the one expected (1), and have been compared to experimental data obtained from clinical trials [10].…”

Transcatheter Stent Therapy in Children: An Update

“…Because of poor surgical results and relatively inaccessible distal branch pulmonary arteries, balloon angioplasty, once described [41,42], was readily accepted as an alternative treatment of BPAS [43][44][45][46]. The initial enthusiasm was high but the low success rate resulted in introduction of high pressure balloons [47].…”

“…The initial enthusiasm was high but the low success rate resulted in introduction of high pressure balloons [47]. Even with this technical improvement, success rate remained low, complication (ruptured pulmonary artery, hemoptysis, pulmonary edema, pulmonary artery aneurysm) rate was high, and recurrence rate was significant [43][44][45][46]. Consequently balloon expandable stents, first introduced by Palmaz et al [7], have been adopted for management of BPAS [11,16,17,[48][49][50] …”

Peripheral Pulmonary Artery Stenosis as a Cause of Pulmonary Hypertension in Adults

“…Treatment for PPAS includes surveillance, for those asymptomatic patients with preserved RV function and symmetric pulmonary blood flow, and balloon angioplasty, 27,28 cutting balloon angioplasty, 29 stent implantation, 30 or surgery, 31 for those with symptoms of right heart failure, substantial elevation of RV pressures, marked asymmetry in pulmonary blood flow (<25% of the total flow to a single lung), severe pulmonary regurgitation, or worsening hemodynamics or RV function. 9 Recurrent stenosis is not uncommon, as it occurs in approximately 35% of successfully dilated vessels.…”