PULMONARY-ARTERY STENOSIS AFTER SYSTEMIC-TO-PULMONARY SHUNT OPERATIONS

Objective: Systemic-to-pulmonary shunt operations are still required f or palliation of certain congenital heart defects. The aim of this stu dy was to analyze the incidence and etiology of the development of pul monary artery stenosis after these procedures. Methods and results: Pr e- and post-operative angiograms of 59 patients who underwent 54 perip heral and 12 central shunt operations were analyzed retrospectively. P atients without prior cardiovascular interventions (group I, n = 47) w ere differentiated from patients with prior interventions (group II, n = 12). In group I, all peripheral shunts were inserted contralaterall y to the ductus arteriosus. Follow-up for all patients was 1.8 years ( 4 days-7.8 years). Pulmonary artery stenosis was diagnosed in 12/59 pa tients (20.3%, group I 12/47; group II 0) after a time interval of 4 d ays up to 5.3 years and only after Blalock-Taussig shunts (one classic al, 11 modified) (12/40 = 30%). The stenoses were located ipsilaterall y to the shunt in 7/12 and contralaterally in 5/12. Statistical analys is did not show any impact of age, weight, sex, shunt type or size, pu lmonary artery diameters, Nakata and McGoon indices and prior interven tions on the development of pulmonary artery stenosis. However, a pate nt ductus arteriosus and administration of Prostaglandin E-1 had a sig nificant impact on the development of pulmonary artery stenosis on the side of the ductus arteriosus. Conclusion: Pulmonary artery stenosis is not a rare event after systemic-to-pulmonary shunt operations. A pa tent ductus arteriosus with or without administration of Prostaglandin Fl is related to pulmonary artery stenosis on the side of the ductus arteriosus. Pulmonary artery stenosis on the side of a peripheral shun t may be caused by inappropriate surgical technique, increased intimal proliferation, or pulmonary artery kinking. Treatment depends on seve rity of cyanosis and on further surgical plans. (C) 1998 Elsevier Scie nce B.V. All rights reserved.