B. Zeevi et al., MIDTERM CLINICAL IMPACT VERSUS PROCEDURAL SUCCESS OF BALLOON ANGIOPLASTY FOR PULMONARY-ARTERY STENOSIS, Pediatric cardiology, 18(2), 1997, pp. 101-106
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.