Percutaneous treatment of stenosed major aortopulmonary collaterals with balloon dilatation and stenting: what can be achieved?
BACKGROUND
The natural history of major aortopulmonary collateral arteries (MAPCAs) in patients with pulmonary atresia and ventricular septal defect (PA-VSD) is frequently complicated by progressive stenosis, leading to pulmonary hypoperfusion and debilitating hypoxaemia.


OBJECTIVE
To evaluate balloon dilatation and stenting for relief of stenoses and improvement of pulmonary flow in patients with PA-VSD.


METHODS
Retrospective analysis of all patients where dilatation of MAPCA stenoses was attempted.


METHODS
Twelve patients with stenotic MAPCAs.


METHODS
Dilatation was attempted in 25 stenoses. Vessels were stented if elastic recoil was noticed (n = 3), in the presence of long segment stenosis (n = 4) or marked tortuosity (n = 1).


METHODS
Diameter of stenoses before and after dilatation as well as arterial oxygen saturation data. Patients proceeding to surgical therapy.


RESULTS
Two stenosed MAPCAs could not be crossed by a catheter. Four lesions were non-dilatable despite the use of high inflation pressures (18 atm). Six stenoses could be completely dilatated using angioplasty only; in five, only partial dilatation was obtained; eight stenoses needed stenting. In the group with partial expansion the mean (SD) diameter increased from 1.7 (0.8) to 3.5 (1.7) mm (p < 0.05); where full dilatation was achieved it increased from 2.1 (0.8) to 4.8 (1.9) mm (p < 0.05); and in the stented group in increased from 2.3 (0.9) to 5.0 (2.5) mm (p < 0.01). Percutaneous arterial oxygen saturation increased from 75(8%) to 82(8)% (p < 0.001). No complications were experienced during the procedures. Repeat dilatation was attempted in six stenoses, but only two procedures were successful. There were two episodes of vasospasm and in one an aneurysm had developed after redilatation. Two patients proceeded to outflow plasty and two subsequently had a unifocalisation procedure.


CONCLUSIONS
Pulmonary blood flow can be improved using balloon angioplasty or stents in patients with stenotic MAPCA; however, 17% of the lesions were not dilatable. Procedures are generally safe, but carry a small risk of vasospasm, dissection, occlusion or aneurysm formation.
Brown
S C
SC
University of the Free State, Bloemfontein, South Africa.
Eyskens
B
B
Mertens
L
L
Dumoulin
M
M
Gewillig
M
M
D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon / Q000379:methods*; D001011:Aorta; D001021:Aortic Valve / Q000002:abnormalities*; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000601:surgery / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications*; D006801:Humans; D007223:Infant; D011651:Pulmonary Artery; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome