title: Hybrid branch pulmonary artery stent placement in adults with congenital heart disease.
abstract: OBJECTIVE
  Valuable treatment modalities for branch pulmonary artery (BPA) stenoses are surgical patch angioplasty, percutaneous BPA stenting and hybrid stent placement. The purpose of this study was to report our institutional experience with hybrid stent placement to relieve BPA stenoses.
  
  
  METHODS
  Between August 2007 and May 2014, 7 adults (5 females) with congenital heart disease (CHD) had elective intraoperative BPA stent placement. All 7 patients had undergone previous surgery [6 tetralogy of Fallot repairs and 1 arterial switch operation for transposition of the great arteries (TGAs)]. A total of 7 stents (4 right pulmonary artery, 3 left pulmonary artery) were implanted under direct vision, concomitant with a pulmonary homograft implantation (tetralogy of Fallot patients), or because percutaneous stenting was not feasible (TGA patient). Retrospective analysis of clinical data, procedural details and outcomes was performed.
  
  
  RESULTS
  Overall, the mean age was 35 ± 7.2 years. Stent implantation was successful in all procedures. The mean postinflation stent diameter was 13.3 ± 2.0 mm. No stent migration, fracture, stent thrombosis, reintervention or deaths occurred. In 1 case the procedure was complicated by a right pulmonary artery tear just distal to the stent which was repaired by surgical patch angioplasty. At a mean follow-up of 55.6 ± 26 months no patient required catheter reintervention or surgery. Echocardiography (mean follow-up 47.1 ± 22 months), MRI (mean follow-up 43.8 ± 37 months) and CT data (mean follow-up 14.8 ± 10 months) demonstrate a BPA diameter increment from a mean 5.57 ± 2.29 to 10.71 ± 2.56 mm.
  
  
  CONCLUSIONS
  Hybrid intraoperative BPA stent placement is safe and effective and can be used as an alternative for surgical patch angioplasty or if percutaneous BPA stenting is not feasible. Short- to mid-term results are good.
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Winston
authors.initials: W
authors.lastname: Lynch
authors.affiliation: Department of Cardiology Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: S Mathijs
authors.initials: SM
authors.lastname: Boekholdt
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
authors.affiliation: Department of Cardiology Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands d.r.koolbergen@amc.nl d.r.koolbergen@lumc.nl.
authors.forename: David R
authors.initials: DR
authors.lastname: Koolbergen
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003251:Constriction, Pathologic; D017548:Echocardiography, Transesophageal; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Branch pulmonary artery; Congenital heart disease; Hybrid; Stent