Korean Circ J.  2012 Jan;42(1):40-45. 10.4070/kcj.2012.42.1.40.

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

• Ko HK
• Kim YH
• Yu JJ
• Ko JK
• Park IS
• Seo DM
• Yun TJ
• Park JJ
• Jang WS

• KMID: 2297906
• DOI: http://doi.org/10.4070/kcj.2012.42.1.40

Abstract

BACKGROUND AND OBJECTIVES
Pulmonary 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 METHODS
A 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.
RESULTS
Percent 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.
CONCLUSION
This 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.

Keyword

Congenital heart disease; Catheterization

MeSH Terms

Arrhythmias, Cardiac
Cardiac Catheterization
Cardiac Catheters
Catheterization
Constriction, Pathologic
Death, Sudden
Follow-Up Studies
Heart
Heart Defects, Congenital
Heart Diseases
Humans
Lung
Perfusion
Pulmonary Artery
Pulmonary Valve Insufficiency
Pulmonary Valve Stenosis
Stents
Ventricular Pressure

Figure

• 

  Fig. 1 Double wire technique in stenosis of both pulmonary arteries. This still frame image shows that two wires were located at both sides of pulmonary arteries for simultaneous ballooning of the stents. A: sit-up view. B: lateral view.

• 

  Fig. 2 Extra-balloon widening of proximal stent for easy-approach. This image showed ballooning (A) of proximal part of stent after implantation first, which made it easier and safer to access distal pulmonary artery next time. Wide opened stent is shown (B).

• 

  Fig. 3 Changes in diameter of pulmonary arterial stenosis and in percent stenosis. This represents increase of diameter in stenotic lesion and decrease of percent stenosis after stent implantation significantly among almost patients.

• 

  Fig. 4 Complications of implantation of pulmonary artery stent. A: after implanting stent vascular leakage was noted (left) then it was repaired by Jostent® Graft Master. After graft implantation within stent, no leakage was found on angiography (right). B: this showed that stent fracture at proximal part of stent was found during follow-up catheterization for evaluating re-stenosis of left pulmonary artery.

Reference

1. Mullins CE, O'Laughlin MP, Vick GW 3rd, et al. Implantation of balloon-expandable intravascular grafts by catheterization in pulmonary arteries and systemic veins. Circulation. 1988. 77:188–199.

2. Hellenbrand WE. Transcatheter therapy for congenital heart disease. Cardiol Clin. 1988. 6:421–436.

3. Rath PC, Sukumar IP. Transcatheter therapy for congenital heart disease. J Assoc Physicians India. 1986. 34:199–201.

4. Chaturvedi RR, Kilner PJ, White PA, Bishop A, Szwarc R, Redington AN. Increased airway pressure and simulated branch pulmonary artery stenosis increase pulmonary regurgitation after repair of tetralogy of Fallot. Real-time analysis with a conductance catheter technique. Circulation. 1997. 95:643–649.

5. Fogelman R, Nykanen D, Smallhorn JF, McCrindle BW, Freedom RM, Benson LN. Endovascular stents in the pulmonary circulation: clinical impact on management and medium-term follow-up. Circulation. 1995. 92:881–885.

6. Oyen WJ, van Oort AM, Tanke RB, van Mill GJ, Aengevaeren WR, Corstens FH. Pulmonary perfusion after endovascular stenting of pulmonary artery stenosis. J Nucl Med. 1995. 36:2006–2008.

7. Latson LA. Interventional catheterization for congenital heart disease--limited "surgery" without the chest scar. Clin Pediatr (Phila). 1997. 36:125–127.

8. Petit CJ, Gillespie MJ, Harris MA, et al. Relief of branch pulmonary artery stenosis reduces pulmonary valve insufficiency in a swine model. J Thorac Cardiovasc Surg. 2009. 138:382–389.

9. Law MA, Shamszad P, Nugent AW, et al. Pulmonary artery stents: long-term follow-up. Catheter Cardiovasc Interv. 2010. 75:757–764.

10. Recto MR, Elbl F, Austin E. Use of the new IntraStent for treatment of transverse arch hypoplasia/coarctation of the aorta. Catheter Cardiovasc Interv. 2001. 53:499–503.

11. Rutledge JM, Mullins CE, Nihill MR, Grifka RG, Vincent JA. Initial experience with intratherapeutics Intrastent Doublestrut LD stents in patients with congenital heart defects. Catheter Cardiovasc Interv. 2002. 56:541–548.

12. Latson LA. Pulmonary artery stents: on target, but still "off label". Catheter Cardiovasc Interv. 2010. 75:765–766.

13. Moszura T, Michalak KW, Dryzek P, Moll JA, Moll J, Sysa A. One center experience in pulmonary artery stenting without long vascular sheath. Cardiol J. 2010. 17:149–156.

14. Tomita H, Nakanishi T, Hamaoka K, Kobayashi T, Ono Y. Stenting in congenital heart disease: medium- and long-term outcomes from the JPIC stent survey. Circ J. 2010. 74:1676–1683.

15. Forbes TJ, Rodriguez-Cruz E, Amin Z, et al. The Genesis stent: a new low-profile stent for use in infants, children, and adults with congenital heart disease. Catheter Cardiovasc Interv. 2003. 59:406–414.

16. Breinholt JP, Nugent AW, Law MA, Justino H, Mullins CE, Ing FF. Stent fractures in congenital heart disease. Catheter Cardiovasc Interv. 2008. 72:977–982.

17. Ashwath R, Gruenstein D, Siwik E. Percutaneous stent placement in children weighing less than 10 kilograms. Pediatr Cardiol. 2008. 29:562–567.

18. Li F, Zhou AQ, Gao W, et al. Therapeutic effect of Cheatham-Platinum stent implantation for vessel stenosis associated with congenital heart disease in children and adolescents. Zhonghua Er Ke Za Zhi. 2009. 47:255–259.

19. Maglione J, Bergersen L, Lock JE, McElhinney DB. Ultra-high-pressure balloon angioplasty for treatment of resistant stenoses within or adjacent to previously implanted pulmonary arterial stents. Circ Cardiovasc Interv. 2009. 2:52–58.