Pulmonary artery stenosis after systemic-to-pulmonary shunt operations.
OBJECTIVE
Systemic-to-pulmonary shunt operations are still required for palliation of certain congenital heart defects. The aim of this study was to analyze the incidence and etiology of the development of pulmonary artery stenosis after these procedures.


RESULTS
Pre- and post-operative angiograms of 59 patients who underwent 54 peripheral and 12 central shunt operations were analyzed retrospectively. Patients without prior cardiovascular interventions (group I, n = 47) were differentiated from patients with prior interventions (group II, n = 12). In group I, all peripheral shunts were inserted contralaterally to the ductus arteriosus. Follow-up for all patients was 1.8 years (4 days-7.8 years). Pulmonary artery stenosis was diagnosed in 12/59 patients (20.3%, group I 12/47; group II 0) after a time interval of 4 days up to 5.3 years and only after Blalock-Taussig shunts (one classical, 11 modified) (12/40 = 30%). The stenoses were located ipsilaterally to the shunt in 7/12 and contralaterally in 5/12. Statistical analysis did not show any impact of age, weight, sex, shunt type or size, pulmonary artery diameters, Nakata and McGoon indices and prior interventions on the development of pulmonary artery stenosis. However, a patent ductus arteriosus and administration of Prostaglandin E1 had a significant impact on the development of pulmonary artery stenosis on the side of the ductus arteriosus.


CONCLUSIONS
Pulmonary artery stenosis is not a rare event after systemic-to-pulmonary shunt operations. A patent ductus arteriosus with or without administration of Prostaglandin E1 is related to pulmonary artery stenosis on the side of the ductus arteriosus. Pulmonary artery stenosis on the side of a peripheral shunt may be caused by inappropriate surgical technique, increased intimal proliferation, or pulmonary artery kinking. Treatment depends on severity of cyanosis and on further surgical plans.
Sachweh
J
J
Department of Thoracic and Cardiovascular Surgery, Klinik für Thorax-, Herz- und Gefässchirurgie, Universitätsklinikum, Aachen, Germany. sachwehjs@aol.com
Däbritz
S
S
Didilis
V
V
Vazquez-Jimenez
J F
JF
v Bernuth
G
G
Messmer
B J
BJ
D000293:Adolescent; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000209:etiology*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D006328:Cardiac Catheterization; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011183:Postoperative Complications; D011651:Pulmonary Artery; D012086:Reoperation; D012189:Retrospective Studies