Expanding indications for the treatment of pulmonary artery stenosis in children by using cutting balloon angioplasty.
OBJECTIVE
To evaluate the role of cutting balloon angioplasty in children with pulmonary artery stenosis.


BACKGROUND
Pulmonary artery stenoses can be either congenital or secondary to postoperative scar formation. Isolated multiple small-vessel pulmonary artery stenoses are very rare. No surgical procedures for their treatment are currently available.


METHODS
We report on four patients in whom standard and high-pressure balloon angioplasty had failed. Three of the four (2.5-, 3-, and 3.5-years-old; two girls) had isolated multiple peripheral pulmonary artery stenosis. The fourth patient was an 11-month-old girl (8 kg) with tetralogy of Fallot and hypoplastic pulmonary artery branches treated with the implantation of two stents in the pulmonary arteries. During the follow-up this patient developed severe intrastent restenosis and showed severely hypoplasic distal left pulmonary artery.


RESULTS
We treated 11 vessels. The mean vessel diameter increased by 81% (P<0.0001) and RV/LV pressure ratio decreased from 1.15 to 0.75 (P=0.05). Patient treated for intrastent restenosis underwent successful complete tetralogy of Fallot repair. None of the patients suffered procedure-related complications. At a median follow-up of 18 months, results were stable and no late complications had occurred.


CONCLUSIONS
Cutting balloon angioplasty is a promising technique for the treatment of highly challenging pathologies such as small vessel pulmonary artery stenoses and intrastent restenosis.
Butera
Gianfranco
G
Pediatric Cardiology, San Donato Milanese, Italy. gianfra.but@lycos.com
Antonio
La Torre Marco
LT
Massimo
Chessa
C
Mario
Carminati
C
D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome