Objective. To clarify the outcome of unilateral pulmonary artery (PA) angioplasty in young children.
Patients and Results:
Since February 1998, 10 patients (7 boys, 3girls) < 15 Kg underwent 22 unilateral PA angioplasty at a median age and weight of 1.9(0.7-3.6) years and 10.2(7.9-15) Kg, respectively. In 8 cases, the PA stenosis developed after an initial surgical reconstruction of the PA, during or after repair of associated cardiac disease: tetralogy of Fallot (n=8), D-transposition of the great arteries (n=1) and right ventricular outflow obstruction (n=1). The interventions were successful in 95% (18 of 20) of the cases. The narrowest mean diameter of the stenotic PA increased from 2.7±1.2mm to 8.9±3mm and the mean pressure gradient dropped from 15.8±10.8mmHg to 4.5±5.5mmHg. Ten stents were implanted in 8 patients: 8 in the left, 2 in the right PA. Lung scan showed a mean increase in perfusion to the affected lung from 15% (+ 11%) to 30% (+ 10%), p= 0.001. Twelve PA redilations were performed in 6 patients. Minor complications were transient pulmonary edema (n=1) and transient hemoptysis (n=1). One stent that migrated in left PA distally was redilated there, whereas another stent was implanted in the stenosis. All patients are asymptomatic after a mean follow-up of 5.8(+0.9 to 9.9) years, with a mean lung perfusion of 32%(+6.5%).
Conclusion.
PAA is efficient in small children with a significant gain in lung perfusion that is maintained during follow-up. Stent placement is often necessary and can be redilated to accommodate somatic growth.