title: Effects of Angle Correction Angioplasty for Pulmonary Artery Stenosis With Tetralogy of Fallot.
abstract: BACKGROUND
  Left pulmonary artery (LPA) stenosis with acute angulation is a common cause of reoperation after tetralogy of Fallot repair. We therefore investigated surgical outcomes of acute-angle correction angioplasty.
  
  
  METHODS
  Between 2005 and 2012, 53 patients underwent operation for LPA stenosis as a concurrent procedure. We divided the patients into two groups according to the LPA ostium angulation: group I (acute angle, acute-angle correction angioplasty, n = 29) and group II (obtuse angle, conventional patch angioplasty, n = 24), encompassing subgroup type I (focal stenosis) and type II (diffuse stenosis). The changes in the z score of LPA and lung perfusion rates were monitored using computed tomography and lung perfusion scans.
  
  
  RESULTS
  The z scores of LPA ostium and hilum were improved at 4.9 mean years of follow-up in group I (p = 0.002, p = 0.041). At the most recent follow-up, there were no differences in the LPA z score (p = 0.177; n = 16 in group I; n = 13 in group II) or left lung perfusion rates (group I: 39.5% ± 9.6%, n = 26; group II: 36.8% ± 11.2%, n = 18, p = 0.418) between the two groups. In group I, the ostial z scores and lung perfusion rates in patients with type II (-4.1 ± 3.1, 25.4%) were lower than patients with type I (-1.6 ± 2.5, 41.0%) at the most recent follow-up (p = 0.069, p = 0.001, respectively). The reoperation or reintervention rate was higher in patients with type II than in patients with type I in group I (p = 0.022).
  
  
  CONCLUSIONS
  Acute-angle correction angioplasty was associated with similar LPA ostium z scores and left lung perfusion rates in the two groups. Diffuse LPA stenosis compromised left lung perfusion and increased reoperation or reintervention rate.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Republic of Korea.
authors.forename: Woo Sung
authors.initials: WS
authors.lastname: Jang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: woonghan@snu.ac.kr.
authors.forename: Woong-Han
authors.initials: WH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Republic of Korea.
authors.forename: Sungkyu
authors.initials: S
authors.lastname: Cho
mesh_terms: D017130:Angioplasty / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012086:Reoperation; D000071079:Stenosis, Pulmonary Artery / Q000628:therapy*; D013771:Tetralogy of Fallot / Q000628:therapy*