title: Bifurcating stents in the pulmonary arteries: A novel technique to relieve bilateral branch pulmonary artery obstruction.
abstract: Balloon angioplasty and stent placement in close proximity to the bifurcation of the branch pulmonary arteries can be challenging. Multiple approaches have been previously described, though none of these approaches both treats bilateral proximal branch pulmonary artery stenosis and provides an anchor for a transcatheter pulmonary valve replacement. We report a novel approach that involves serial stent placement and balloon dilation through the struts of the stent in each pulmonary artery, along with balloon expansion of the proximal portion of the stents to the diameter of the main pulmonary artery. In the two cases we describe, this strategy resulted in significant relief of branch pulmonary artery obstruction without compromising the anatomy of the main pulmonary artery segment. This technique can be an effective way to alleviate stenoses of the bilateral proximal branch pulmonary arteries and provides a landing zone for a future transcatheter pulmonary valve.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Hari K
authors.initials: HK
authors.lastname: Narayan
authors.affiliation: Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
authors.affiliation: Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography / Q000379:methods; D000800:Angioplasty, Balloon / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*; D018570:Risk Assessment; D012494:Sampling Studies; D015607:Stents; D013771:Tetralogy of Fallot / Q000601:surgery; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000628:therapy
keywords: melody valve; pulmonary valve insufficiency; stenosis; tetralogy of Fallot; transcatheter pulmonary valve replacement