Percutaneous selective pulmonary artery bands (Joeys) in a pulmonary overcirculation model.
BACKGROUND
Control of distal pulmonary artery (PA) pressure and flow is a critical step in palliating infants with complex congential heart disease. Surgical procedures to protect or isolate the pulmonary circulation carry significant risk and can be unpredictable. Interventional control of pulmonary pressure/flow with an intravascular device (band) could reduce risk and improve regulation of pulmonary flow.


METHODS
Internal pulmonary bands were created from woven nitinol to create an internal orifice estimated to reduce distal pulmonary arterial pressure by 50%. Two designs were tested, a single eccentric lumen and two symmetrical lumens. The devices were approximately 7-mm long and the external diameter varied to suit the pulmonary arterial lumen size. A total of 15 devices were implanted in seven lambs with a stented ductus arteriosus to create high pulmonary pressure/flow. Four lambs were followed with devices and stent in place for a mean of 37 +/- 13 days.


RESULTS
Fourteen of 15 devices were successfully implanted. One was acutely removed since the size was too large. Both device designs created greater than a 50% reduction in distal pulmonary pressure. Main PA pressure was 70/38, mean 50 +/- 13 mm Hg, and distal PA pressure 25/16, mean 20 +/- 7 mm Hg (P < 0.05). Angiography demonstrated protection of the internal banded pulmonary segments from overcirculation. Late follow-up showed that the device lumen(s) remained patent. Histology showed the vessel media to be intact but there was intimal proliferation where the device approximated the wall. There were no thrombotic emboli detected.


CONCLUSIONS
Percutaneous internal banding of the pulmonary arteries was feasible and successful in lambs with high pulmonary flow/pressure analogous to infants with complex congenital heart disease.
Boucek
Mark M
MM
Division of Pediatric Cardiology, Joe DiMaggio Children's Hospital, Hollywood, Florida 33021, USA. mboucek@mhs.net
Chan
Kak-Chen
KC
Bright
Janice M
JM
D000497:Alloys; D000792:Angiography; D000818:Animals; D000831:Animals, Newborn; D001794:Blood Pressure; D006328:Cardiac Catheterization; D004195:Disease Models, Animal; D004373:Ductus Arteriosus / Q000601:surgery; D004867:Equipment Design; D005240:Feasibility Studies; D006330:Heart Defects, Congenital / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011651:Pulmonary Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation; D012756:Sheep; D015607:Stents; D013997:Time Factors; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000295:instrumentation*
D000497:Alloys; C013616:nitinol