Pulmonary artery growth after palliation of congenital heart disease with duct-dependent pulmonary circulation: arterial duct stenting versus surgical shunt.
OBJECTIVE
The aim of this study was to compare the pulmonary artery (PA) growth after arterial duct (AD) stenting versus modified Blalock-Taussig shunt (MBTS) in neonates with congenital heart disease with duct-dependent pulmonary circulation (CHD-DPC).


BACKGROUND
Arterial duct stenting is increasingly deemed a reliable alternative to surgical shunt in CHD-DPC. A stented duct might better adapt to the PA anatomy than a surgical conduit, thereby promoting a more uniform PA development.


METHODS
This study enrolled 27 patients with CHD-DPC submitted to AD stenting (n = 13, Group I) or MBTS (n = 14, Group II) at our institution. The PA growth was angiographically assessed with the Nakata and McGoon indexes as well as the individual PA z-scores. The right-to-left PA diameter ratio was considered as index of uniform growth.


RESULTS
After 10 +/- 5 months, both options had promoted a significant increase of the Nakata index (from 136 +/- 72 mm/m(2) to 294 +/- 99 mm/m(2), p < 0.0001, Group I; from 151 +/- 74 mm/m(2) to 295 +/- 177 mm/m(2), p < 0.003, Group II) and McGoon ratio (from 1.5 +/- 0.3 to 2.1 +/- 0.3, p < 0.0001, Group I; from 1.6 +/- 0.3 to 2.0 +/- 0.5, p < 0.01, Group II). However, the surgical shunt had caused a worsening of the left-to-right PA diameter ratio compared with AD stenting (0.9 +/- 0.1 Group I vs. 1.6 +/- 0.9 Group II, p < 0.01), due to preferential growth of the PA contralateral to the shunt.


CONCLUSIONS
Percutaneous AD stenting is as effective as MBTS in promoting a global PA growth in CHD-DPC. In addition, it ensures an even distribution of the pulmonary blood flow, thereby promoting a more balanced pulmonary vascular development than MBTS.
Santoro
Giuseppe
G
Division of Cardiology, A.O. Monaldi, Second University of Naples, Via Vito Lembo 14, 84131 Salerno, Italy. santoropino@tin.it
Capozzi
Giovanbattista
G
Caianiello
Giuseppe
G
Palladino
Maria Teresa
MT
Marrone
Chiara
C
Farina
Gabriella
G
Russo
Maria Giovanna
MG
Calabrò
Raffaele
R
D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006328:Cardiac Catheterization; D005500:Follow-Up Studies; D018610:Heart Bypass, Right / Q000379:methods*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011651:Pulmonary Artery / Q000254:growth & development* / Q000601:surgery; D011652:Pulmonary Circulation / Q000502:physiology*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome