title: Simultaneous stent implantation to treat bifurcation stenoses in the pulmonary arteries: Initial results and long-term follow up.
abstract: BACKGROUND
  Balloon angioplasty of bifurcating pulmonary artery (PA) stenoses is often inadequate, and stent treatment often requires simultaneous implantation of two stents. This study evaluates initial results and long-term follow up of transcatheter stent placement in bifurcating PAs.
  
  
  METHODS
  This is a retrospective review of patients (pts) who had bifurcating PA stents placed in main and lobar branches from 1993 to 2007.
  
  
  RESULTS
  Forty-nine pts had bifurcating PA stents placed at a median age of 10.9 years (range 1-43 years). The mean minimum vessel diameter increased from 5.7 +/- 2.5 mm to 11.0 +/- 3.6 mm (P < 0.001), the mean gradient across the stenoses decreased from 37.0 +/- 26.9 to 9.2 +/- 13 mm Hg (P < 0.001), whereas the mean RV:FA ratio decreased from 0.76 +/- 0.29 to 0.53 +/- 0.24 (P < 0.001). There was one death due to severe pulmonary hemorrhage. F/U data were available in 38 pts (mean duration 6.3 +/- 4.1 years, range 1.2-13.1 years). Thirty pts underwent repeat catheterizations (mean 2.3 +/- 2.2 years poststent), with 26 requiring further interventions: Fifteen had balloon angioplasty alone and 11 had additional stents placed. There were no complications at f/u catheterization. Six pts underwent further palliative surgeries, although none for repair of branch PA stenoses.
  
  
  CONCLUSIONS
  Simultaneous transcatheter placement of bifurcating PA stents provides immediate gradient relief of bifurcating stenoses in the proximal or lobar branch PAs and reduces RV systolic pressure. Further interventions can be safely performed in future procedures, and the presence of stents does not complicate future surgeries.
authors.affiliation: Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Gary E
authors.initials: GE
authors.lastname: Stapleton
authors.forename: Rabih
authors.initials: R
authors.lastname: Hamzeh
authors.forename: Charles E
authors.initials: CE
authors.lastname: Mullins
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Zellers
authors.forename: Henri
authors.initials: H
authors.lastname: Justino
authors.forename: Alan
authors.initials: A
authors.lastname: Nugent
authors.forename: Michael R
authors.initials: MR
authors.lastname: Nihill
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Grifka
authors.forename: Frank F
authors.initials: FF
authors.lastname: Ing
mesh_terms: D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000473:pathology / Q000503:physiopathology; D015641:Radiography, Interventional; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D016278:Ventricular Function, Right; D017725:Ventricular Pressure; D055815:Young Adult