Aim: The stenting of proximal pulmonary artery or conduit bifurcation stenosis remains challenging. We sought to place a stent across such lesions which was mounted onto two balloon angioplasty catheters placed within the respective distal branch pulmonary arteries.
Methods: Over a 4 year period four patients were identified with significant branch pulmonary artery stenosis just proximal to a bifurcation, which could not be improved by single and double balloon angioplasty. The insertion of a standard stent was judged to be unsatisfactory, due to potential jailing of a branch PA, or having to severely oversize the balloon. A large bore Mullins sheath was placed just proximal to the stenosis, two guidewires were placed within the branch PAs. A stent with minimal shortening characteristics (EV3 in 3, Genesis in 1) was mounted onto two balloon angioplasty catheters in tandem and then delivered.
Results: Mullins sheath sizes were 16F in one, 14F in two and 12F in one. In one patient an 18mm angioplasty and a 5F Judkins were used for mounting the stent. The procedures were uneventful in all. Conduit gradients were reduced in 3 from mean 55-15 mmHg. One patient with branch PA stenosis had marked improvement in morphology and perfusion.
Conclusion: The described technique is an effective and safe technique in treatment of selected proximal bifurcation stenoses.