PERCUTANEOUS USE OF STENTS TO CORRECT PULMONARY-ARTERY STENOSIS IN YOUNG-CHILDREN AFTER CAVOPULMONARY ANASTOMOSIS

Pulmonary artery distortion is a risk factor among candidates for the Fontan procedure. In 57 patients evaluated by catheterization after su ccessful cavopulmonary anastomosis, 8 had proximal left pulmonary arte ry (LPA) stenosis, either discrete (4 patients) or long segment (4 pat ients). Median age was 27 months (range 19 to 60 months). Median weigh t was 11.4 kg (range 9.1 to 20.0). Mean diameter at LPA stenosis was 4 .4 +/- 0.4. Proximal right pulmonary artery mean diameter was 10.4 +/- 1.0 mm. After angiographic and hemodynamic assessment, short 11F shea ths were placed in the right internal jugular (6 patients) or subclavi an veins (2 patients). Pulmonary artery angioplasty and stent placemen t were performed. LPA stenoses were enlarged using 10 Palmaz stents di lated to 10 mm (7 patients) or to 12 mm (3 patients). Poststent angiog rams showed that narrowest LPA dimensions were significantly enlarged to 9.9 mm +/- 1.0 mm, p < 001). There were no complications. Follow-up studies (catheterizations in 4 patients, echocardiograms in 8 patient s) were performed 4 to 9 months after stent implantation. No restenosi s was observed. Five patients had completion of their Fontan procedure s; three patients are pending Fontan completion. This study demonstrat es the efficacy and safety of the percutaneous use of Palmaz stents to correct pulmonary artery stenosis in young children after cavopulmona ry anastomosis.