Surgical Reconstruction of Peripheral Pulmonary Arteries: Strategies, Outcomes, and New Classification.

BACKGROUND: Pulmonary artery stenosis (PAS) is classified as central (types 1 and 2) and peripheral (type 3 affects proximal part of lobar arteries, type 4 affects proximal part of segmental arteries, and type 5 affects distal part of segmental arteries). In this study, we examine the outcomes of surgical reconstruction of peripheral PAS. METHODS: We reviewed 31 patients with peripheral PAS who underwent surgical repair. Median age was 30 months. Patients with intact ventricular septum (24 patients) presented with severe right ventricular dilation and dysfunction and mean right ventricular to left ventricular pressure (RVSP/LVSP) ratio was 0.96 ± 0.25, 1.14 ± 0.23, and 1.43 ± 0.07 for types 3, 4, and 5, respectively (p = 0.03). Pulmonary artery reconstruction was achieved in single stage in 19 patients (61%). RESULTS: Six patients (19%) had type 3, 22 patients (71%) had type 4, and 3 patients (10%) had type 5. mean number of angioplasties per patient was 18 ± 8. There was no early mortality. Mean postoperative RVSP/LVSP ratio decreased to 0.27 ± 0.08, 0.36 ± 0.05, and 0.96 ± 0.06, for types 3, 4, and 5, respectively (p < 0.001). The median follow-up was 48 months. Patients with type 3 and 4 showed marked improvement in functional status after surgery. Patients with type 5 showed clinical evidence of improved cardiac output despite modest decrease in RVSP. No surgical re-intervention was needed, while balloon dilation was performed in 1 patient with type 5 lesions. CONCLUSIONS: Surgical reconstruction of diffuse peripheral PAS is feasible and associated with excellent hemodynamic and functional outcomes in patients where there is no involvement of the distal part of segmental arteries.

[Balloon dilatation of the pulmonary valve. Short-, middle- and long-term results]. / Die Ballondilatation der Pulmonalklappe. Kurz-, mittel- und langfristige Ergebnisse.

BACKGROUND: Immediate and long-term results after balloon dilatation of pulmonary valve stenosis in our unit. METHODS AND PATIENTS: All 111 patients (1 day-18 years) who have had balloon dilatation of a pulmonary valvar stenosis between 12/1987 and 8/1997 were divided into 4 groups: Typical valvar pulmonary stenosis (group A; n = 78), stenosis with dysplastic pulmonary valve (group B; n = 10), critical pulmonary stenosis (group C; n = 16) and pulmonary atresia after transcatheter or operative opening of the valve (group D; n = 7). Patients with pulmonary stenosis and complex congenital heart disease were excluded. RESULTS: The average systolic transvalvular gradient was reduced from 68.5 to 27.2 mmHg (60%) immediately after balloon dilatation. After a follow up of 48.8 +/- 37 months 101 patients could be reevaluated. In group A (n = 69 at FU) and C (n = 16 at FU) 81% showed a systolic transvalvular gradient < 30 mmHg after one and 83% (A) respective 94% (C) after two balloon dilatations. In group B (n = 9 at FU) 44% exhibited a systolic gradient < 30 mmHg after one and 56% after two balloon dilatations. In group D (n = 7 at FU) 57% showed a systolic gradient < 30 mmHg with no further improvement by a second dilatation. Over all, 80% of our patients could be treated sufficiently by transcatheter means. The rate of major complications was 7.3% with no lasting residuals at follow up and no deaths. CONCLUSION: Balloon dilatation of the pulmonary valve is secure and effective. Best results are obtained in patients with typical pulmonary valve stenosis and in newborns and infants with critical pulmonary valve stenosis.