title: Pulmonary artery stenosis in hybrid single-ventricle palliation: High incidence of left pulmonary artery intervention.
abstract: OBJECTIVE
  Pulmonary artery growth is an important determinant of outcome in single-ventricle strategies. Higher rates of pulmonary artery intervention have been reported with hybrid-based palliation when compared with Norwood palliation.
  
  
  METHODS
  We performed a retrospective review of pulmonary artery growth and clinical outcomes in patients undergoing hybrid-based single-ventricle palliation.
  
  
  RESULTS
  The stage I hybrid procedure was performed in 72 patients between 2004 and 2012, of whom 54 were on a Fontan palliative pathway. Thirty-four infants completed stage II, and 20 infants underwent the Fontan operation. The mean diameters of the right pulmonary artery (5.6 ± 1.9 mm) and left pulmonary artery (5.6 ± 2.1 mm) were similar before stage II. After stage II, the right and left pulmonary artery diameters were 8.5 ± 2.1 mm and 5.8 ± 1.3 mm, respectively (P < .001), and after the Fontan operation, these were 8.8 ± 2.0 mm and 6.4 ± 1.1 mm, respectively (P = .002). The mean right pulmonary artery z score was normal throughout, but the left pulmonary artery did not maintain a normal size. The cumulative pulmonary artery intervention rate was 50% at any time after stage II. Fifteen interventions (88%) were performed after stage II (35% during the same hospitalization, 71% <60 days). The most intervened site was the midsection of the left pulmonary artery (41%). Initial pulmonary artery intervention was balloon dilation in 59% of patients and stent implantation in 41% of patients. Half of patients with initial balloon dilation required reintervention.
  
  
  CONCLUSIONS
  There is significant risk of left pulmonary artery compromise after the second stage of hybrid palliation associated with a high intervention rate.
authors.affiliation: Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada.
authors.forename: Otto
authors.initials: O
authors.lastname: Rahkonen
authors.affiliation: Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada.
authors.forename: Rajiv R
authors.initials: RR
authors.lastname: Chaturvedi
authors.affiliation: Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada.
authors.forename: Lee
authors.initials: L
authors.lastname: Benson
authors.affiliation: Labatt Family Heart Centre, Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada.
authors.forename: Osami
authors.initials: O
authors.lastname: Honjo
authors.affiliation: Labatt Family Heart Centre, Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Caldarone
authors.affiliation: Labatt Family Heart Centre, Division of Cardiology, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, Canada. Electronic address: kyong-jin.lee@sickkids.ca.
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000295:instrumentation; D002675:Child, Preschool; D003251:Constriction, Pathologic; D018729:Fontan Procedure / Q000009:adverse effects* / Q000401:mortality; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010166:Palliative Care; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome