Treatment of pulmonary artery stenosis after arterial switch operation: Stent implantation vs. balloon angioplasty

The development of pulmonary artery stenosis is a potential complication du ring the mid- to long-term follow-up after arterial switch operation (ASC) for transposition of the great arteries. Surgical results have been disappo inting and conventional balloon dilation yields a fairly important incidenc e of failures and recurrences. We evaluated our results with implantation o f balloon-expandable stents in 5 out of 13 patients with a previously attem pted unsuccessful conventional balloon dilation of pulmonary artery branch stenosis after ASO. In two more cases, stents were used as a primary proced ure, Balloon angioplasty achieved a 15% increase in mean diameter of the st enosis vs. 124% with the use of stents (P < 0.01), a 10% decrease of the pr essure gradient across the stenosis vs. 71% of stents (P < 0.01), and a 10% drop in RV/aorta pressure ratio vs, 43% of stents (P < 0.01). Compared to conventional balloon angioplasty in our series, stents were more effective in the treatment of patients with peripheral pulmonary artery stenosis afte r ASO. Balloon dilation should be considered in selected cases unsuitable f or treatment with endovascular stents, (C) 2000 Wiley-Liss, Inc.