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Vascular anatomy in children with pulmonary hypertension regarding the transcatheter Potts shunt
  1. Aleksander Sizarov1,
  2. Francesca Raimondi1,2,
  3. Damien Bonnet1,3,
  4. Younes Boudjemline1,3
  1. 1Cardiologie pédiatrique, Centre de Référence Malformations Cardiaques Congénitales Complexes, Hôpital Universitair Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France
  2. 2Service de Radiologie pédiatrique, Hôpital Universitair Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France
  3. 3Université Paris V Descartes, Paris, France
  1. Correspondence to Dr Younes Boudjemline,Cardiologie pédiatrique, Hôpital Necker Enfants Malades, 149 rue de Sèvres, Paris cedex 75015, France; younes.boudjemline{at}aphp.fr

Abstract

Objective To morphometrically characterise the region of adjacent descending aorta (DAo) and left pulmonary artery (LPA) regarding the transcatheter creation of the reverse Potts shunt.

Methods and results Retrospective review of the invasive haemodynamic data and measurements of the vessel diameters, distances and angles based on the thoracic CT of children with idiopathic pulmonary arterial hypertension (PAH) with pulmonary-to-systemic systolic pressure ratio ≥0.5. Forty-eight CT scans from 47 patients were analysed. Independent of the PAH severity, the diameters of DAo and LPA, and the area of tightest contact between these vessels were very similar in patients with either infrasystemic or isosystemic/suprasystemic PAH. For total population, the tightest contact area (mean±SD, 51.8±31.9 mm2, range 12.5–177.7 mm2) had an elliptic shape stretched along the DAo length and LPA width. The shortest mean DAo-LPA distance was 1.7±0.8 mm (range 1–5 mm). Only one patient, from the suprasystemic PAH group, had the DAo-LPA distance >4 mm. None had lung tissue identified between these two vessels, while in four patients (8.3%) the prominent bronchial artery was seen coursing exactly between the LPA and DAo. The difference of prevalence of the bronchial arteries between two vessels in patients with either infrasystemic PAH or isosystemic/suprasystemic PAH did not reach statistical significance.

Conclusions Children with idiopathic PAH showed no complicating anatomic or morphometric parameters of the region with adjacent DAo and LPA, which potentially determine the planning of the transcatheter creation of Potts shunt. It holds promises for standardisation of the procedure in the future.

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