Early results and follow-up of balloon angioplasty for branch pulmonary artery stenoses

AbstractTwo hundred eighteen balloon angioplasty procedures were performed in 135 patients with branch pulmonary artery stenoses from June 1984 to February 1989. Arteries were dilated in patients with tetralogy of Fallot (n = 49), tetralogy of Fallot/pulmonary atresia (n = 64), isolated peripheral pulmonary artery stenoses (n = 58) and “other” lesions (the majority had truncus arteriosus or single ventricle and surgically induced pulmonary artery stenoses (n = 47). Mean age at dilation was 6.6 ± 6.3 years (range 1 month to 38.5 years). The mean diameter of the lesion increased from 3.8 ± 1.7 to 5.5 ± 2.1 mm with dilation (p = 0.0001). The overall success rate was 58% (127 of 218 dilations), assessed by the following criteria: an increase ≥50% of predilation diameter, an increase >20% in flow to the affected lung or a decrease >20% in systolic right ventricular to aortic pressure ratio. Success did not correlate with patient age. Mean balloon to artery ratio was higher in successful (4.2) than in failed (3.0) angioplasty procedures (p = 0.0001).There were four early deaths: two of the patients had pulmonary artery rupture with angioplasty performed < 1 month after pulmonary artery surgery. An aneurysm occurred in 11 arteries and transient pulmonary edema in four patients. At angiography performed a mean of 10 months (range 1 to 54) after dilation, the mean diameter of 57 arteries was unchanged (5.5 versus 5.4 mm). However, 5 of 32 initially successfully dilated vessels had returned to predilation size as a result of restenosis. The most recent experience with angioplasty for branch pulmonary artery stenoses indicates a success rate of 60%, a mortality rate of 1% and a risk of aneurysm formation of 3%