Stenting of stenosed aortopulmonary collaterals and shunts for palliation of pulmonary atresia/ventricular septal defect

Patients with unrepaired pulmonary artery atresia and ventricular septal de fect (PA/VSD) depend on aortoplumonary collaterals and surgically created s hunts for pulmonary blood flow. These vessels frequently develop stenoses w ith time, leading to hypoperfusion of lung segments and systemic hypoxemia. The purpose of this article is to describe catheter palliation of hypoxemi c patients with PA/VSD who were not candidates for surgical repair. We pres ent our experience with stent implantation for stenosis of aortopulmonary c ollaterals and shunts in these patients. Three patients with hypoplastic pu lmonary arteries underwent stent placement in aortopulmonary collateral art eries (APCAs) or their shunts. Technical aspects of the interventional cath eterization procedure are discussed in detail. Case I underwent placement o f five stents in collateral vessels and one stent in the Blalock-Taussig sh unt (BT) with dramatic increase in vessel size and improvement in saturatio ns from 70% to 89%. Case 2 underwent placement of two overlapping stents in a collateral vessel with an increase in diameter of the collateral vessel from 2.3 to 6 mm and an improvement in saturation from 68% to 88%. Case 3 u nderwent: placement of three overlapping stents in a BT shunt with an incre ase in diameter of the shunt from 2.2 to 6.6 mm and an improvement in satur ation from 71% to 89%. All three patients had excellent clinical improvemen t and stable saturation at follow-up. Stent placement for maintaining paten cy of APCAs and aortopulmonary shunts is feasible and safe. (C) 2000 Wiley- Liss, Inc.