MIDTERM CLINICAL IMPACT VERSUS PROCEDURAL SUCCESS OF BALLOON ANGIOPLASTY FOR PULMONARY-ARTERY STENOSIS

The objective of this study was to determine the procedural success ra te of balloon angioplasty for branch pulmonary artery stenosis in term s of its clinical impact on the subsequent management of these patient s. Most previous studies of balloon angioplasty have concentrated on t he initial success rate (50-60%), complications (6-10%), recurrence ra te (similar to 15%), and technical issues. A favorable clinical impact was noted in only 35% of patients. Over a 3-year period (March 1990 t o March 1993), 32 patients (17 boys, 15 girls) underwent 34 balloon an gioplasty procedures. Their mean age at dilation was 7.6 +/- 4.3 years (range 1.1-19.0 years). Postoperative tetralogy of Fallot and tetralo gy of Fallot with pulmonary atresia were the most frequent cardiac les ions (44%). The procedures were ''technically'' successful in 56% (19 of 34) of balloon dilations on the basis of at least two of the follow ing criteria: an increase of >50% of the predilation diameter; an incr ease of >20% in the relative flow to the affected lung by radioisotope study; or a decrease in the systolic right ventricular/aortic pressur e ratio from 85-100% to <60%. Twelve percent of the patients had trans ient complications (two deep vein thromboses, one unilateral pulmonary edema, and one pneumothorax). In 17 of 19 (89%) of the patients there was a favorable clinical impact on their subsequent care as based on one of the following criteria: resolution of the stenosis and avoidanc e of surgical intervention (n = 14); optimization of future surgical p rocedure (n = 3); reduction in right ventricular pressure to <60% of a ortic pressure (n = 13). Five patients who had unsuccessful balloon an gioplasty and one with initially successful balloon angioplasty later underwent endovascular stent placement, which also favorably influence d their clinical status. The success rate of balloon angioplasty for b ranch pulmonary artery stenosis, when measured by strict procedural cr iteria, is accompanied by a favorable clinical impact in more than 50% of patients. Hence this procedure should be the initial therapeutic m odality in this setting despite the relatively high transient complica tion rate. The use of endovascular stents probably increases the favor able clinical impact.