Heart 1998;79:24-28 ( January )
Percutaneous treatment of stenosed major aortopulmonary collaterals with balloon dilatation and stenting: what can be achieved?
a Paediatric Cardiology, University Hospital
Gasthuisberg, Leuven, Belgium, b Paediatric Cardiology,
University of the Free State, Bloemfontein, South Africa
Correspondence to: Dr Gewillig, Paediatric Cardiology, UZ Gasthuisberg, Herestraat 49, B 3000, Leuven, Belgium. email: marc.gewillig{at}uz.kuleuven.ac.be
Accepted for publication 29 September 1997
Background
The natural history of major
aortopulmonary collateral arteries (MAPCAs) in patients with pulmonary
atresia and ventricular septal defect (PA-VSD) is frequently
complicated by progressive stenosis, leading to pulmonary hypoperfusion
and debilitating hypoxaemia.
ObjectiveTo evaluate balloon dilatation and
stenting for relief of stenoses and improvement of pulmonary flow in
patients with PA-VSD.
DesignRetrospective analysis of all patients
where dilatation of MAPCA stenoses was attempted.
PatientsTwelve patients with stenotic MAPCAs.
InterventionsDilatation was attempted in 25 stenoses. Vessels were stented if elastic recoil was noticed (n = 3),
in the presence of long segment stenosis (n = 4) or marked tortuosity
(n = 1).
Main outcome measuresDiameter of stenoses before
and after dilatation as well as arterial oxygen saturation data.
Patients proceeding to surgical therapy.
ResultsTwo stenosed MAPCAs could not be crossed
by a catheter. Four lesions were non-dilatable despite the use of high
inflation pressures (18 atm). Six stenoses could be completely
dilatated using angioplasty only; in five, only partial dilatation
was obtained; eight stenoses needed stenting. In the group with partial
expansion the mean (SD) diameter increased from 1.7 (0.8) to
3.5 (1.7) mm (p < 0.05); where full dilatation was achieved it
increased from 2.1 (0.8) to 4.8 (1.9) mm (p < 0.05); and in the
stented group it increased from 2.3 (0.9) to 5.0 (2.5) mm
(p < 0.01). Percutaneous arterial oxygen saturation increased from
75(8)% to 82(8)% (p < 0.001). No complications were experienced
during the procedures. Repeat dilatation was attempted in six stenoses,
but only two procedures were successful. There were two episodes of
vasospasm and in one an aneurysm had developed after redilatation. Two
patients proceeded to outflow plasty and two subsequently had a
unifocalisation procedure.
ConclusionsPulmonary blood flow can be improved
using balloon angioplasty or stents in patients with stenotic MAPCA;
however, 17% of the lesions were not dilatable. Procedures are
generally safe, but carry a small risk of vasospasm, dissection,
occlusion or aneurysm formation.
© 1998 by Heart
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