Stent implantation and balloon angioplasty for treatment of branch pulmonary artery stenosis in children.
OBJECTIVE
Comparison of the results of branch pulmonary artery stenosis treated with balloon angioplasty (BA) or stent implantation (SI) in children.


BACKGROUND
Branch pulmonary artery stenosis may be treated with BA or SI.


METHODS
We compared the results of 147 interventions of branch pulmonary artery stenosis in 87 children (median age 3.6 years). Patients were treated during 1989-2000 with BA and during 2001-2004 with SI. Primary endpoints were acute complications and reintervention during follow up. Secondary variables were age, vessel diameter increase, acute success rate, balloon/vessel diameter ratio, pulmonary artery hypoplasia indices, and procedure related factors.


RESULTS
The acute vessel diameter increase with BA (4.31 +/- 1.98 vs. 7.15 +/- 2.31 mm) and SI (3.71 +/- 1.58 vs. 6.97 +/- 2.68 mm) was significant within both groups (P < 0.001), but not between both groups. The reintervention rate was comparable between both groups, but median time to reintervention was shorter after SI in infants compared to BA. The balloon/vessel diameter ratio was on average higher in BA than the stent/vessel diameter ratio in SI (3.49 +/- 2.16 vs. 2.42 +/- 0.56; P < 0.05) and was a significant risk factor (P < 0.01) for the higher complication rate after BA (BA: 14.1% vs. SI: 4.8%). No mortality occurred in both groups.


CONCLUSIONS
BA and SI are safe interventional catheter therapies of branch pulmonary artery stenosis. The immediate results of BA and SI are comparable. The higher complication rate after BA, especially in infants, was associated with a higher balloon/vessel diameter ratio. SI seems to be a safe permanent alternative with foreign material, but requires more reinterventions in infants due to its therapeutic strategy.
Baerlocher
Lorenz
L
Division of Paediatric Cardiology, University Children's Hospital Zurich, Steinwiesstr. 75, 8032, Zürich, Switzerland.
Kretschmar
Oliver
O
Harpes
Paul
P
Arbenz
Urs
U
Berger
Felix
F
Knirsch
Walter
W
D000293:Adolescent; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome