title: Intraoperative Stenting of Pulmonary Artery Stenosis in Children With Congenital Heart Disease.
abstract: BACKGROUND
  Branch pulmonary artery (BPA) stenosis is frequently associated with congenital heart disease. Management of BPA stenosis is challenging for surgeons due to a high rate of recurrence. The purpose of this study was to assess the results of intraoperative pulmonary artery stenting associated with or without surgical angioplasty.
  
  
  METHODS
  We included 33 children from our center between January 2008 and July 2014. Patients had pulmonary atresia with ventricular septal defect (13), tetralogy of Fallot (10), troncus arteriosus (4), double outlet right ventricle (2), and single left or right ventricle (4). A total of 44 balloon-expandable stents (mean diameter, 9.5 mm; range, 4 to 16 mm) were deployed in left or right PA under direct visualization, without the use of fluoroscopy, after branch angioplasty for 28 of them (64%). The mean age at surgery was 4.3 ± 4.3 years (range, 6 days to 15 years) and the mean weight was 14.3 ± 11.9 kg (range, 2.8 to 63 kg).
  
  
  RESULTS
  Postoperative mortality was 9% (3 patients), but only 1 death was related to the stenting procedure. Twenty-five patients underwent angiographic control after a mean follow-up of 22 months after surgery. All stents were well positioned. The mean stented BPA Z-score increased from -2.6 ± 1.8 to -0.4 ± 1.6 (p < 0.0001). Eleven patients experienced intrastent proliferation (44%). Among them, 2 patients required a reoperation for severe intrastent stenosis, whereas the 9 others had mild intrastent neointimal proliferation, which was successfully managed by balloon expansion.
  
  
  CONCLUSIONS
  Intraoperative stenting of BPA is a safe and effective option to treat BPA stenosis and prevent recurrence.
authors.affiliation: Pediatric Cardiac Surgery Unit, Clocheville Hospital, CHRU Tours, Tours, France; François-Rabelais University, Tours, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Meot
authors.affiliation: Pediatric Cardiac Surgery Unit, Clocheville Hospital, CHRU Tours, Tours, France; François-Rabelais University, Tours, France; U1069 "Nutrition, Croissance et Cancer", Inserm, Tours, France. Electronic address: lefort81@gmail.com.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lefort
authors.affiliation: Pediatric Cardiac Surgery Unit, Clocheville Hospital, CHRU Tours, Tours, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: El Arid
authors.affiliation: Pediatric Cardiac Surgery Unit, Clocheville Hospital, CHRU Tours, Tours, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Soulé
authors.affiliation: Pediatric Cardiac Surgery Unit, Clocheville Hospital, CHRU Tours, Tours, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Lothion-Boulanger
authors.affiliation: Pediatric Anesthesiology Unit, Clocheville Hospital, CHRU Tours, Tours, France.
authors.forename: François
authors.initials: F
authors.lastname: Lengellé
authors.affiliation: Pediatric Cardiac Surgery Unit, Clocheville Hospital, CHRU Tours, Tours, France; François-Rabelais University, Tours, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Chantepie
authors.affiliation: Pediatric Cardiac Surgery Unit, Clocheville Hospital, CHRU Tours, Tours, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Neville
mesh_terms: D000293:Adolescent; D000792:Angiography; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007432:Intraoperative Period; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D000071079:Stenosis, Pulmonary Artery / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome