Abstract
Stenosis of the pulmonary arteries frequently occurs during staged palliation of hypoplastic left heart syndrome and variants, often necessitating stent angioplasty. A complication of stent angioplasty is compression of the ipsilateral mainstem bronchus. Following such a case, we re-evaluated our approach to PA stent angioplasty in these patients. The incident case is described. A retrospective observational study of children and adults with superior (SCPC) and/or total cavopulmonary connection (TCPC) undergoing left pulmonary artery (LPA) stent angioplasty between January 1, 2005 and January 5, 2014 and subsequent chest CT was performed to assess the incidence of bronchial compression. The current strategy of employing bronchoscopy to assess bronchial compression during angioplasty is described with short-term results. Sixty-five children and adults underwent LPA stent angioplasty. Other than the incident case, none had symptomatic bronchial compression. Of the total study population, 12 % had subsequent CT, of which one subject had moderate bronchial compression. To date, seven subjects have undergone angioplasty of LPA stenosis and bronchoscopy. In one case, stent angioplasty was not performed because of baseline bronchial compression, exacerbated during angioplasty. In the rest of cases, mild-moderate compression was seen during angioplasty. Following stent angioplasty, the resultant compression was not worse than that seen on test angioplasty. Bronchial compression is a rare complication of stent angioplasty of the pulmonary arteries in children and adults with SCPC/TCPC. Angioplasty of the region of interest with procedural bronchoscopy can help to identify patients at risk of this complication.
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Dr. O’Byrne receives support from the National Institutes of Health [T32 HL007915] and Entelligence Young Investigator grant. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health. The supporting agencies had no role in the design, conduct, interpretation, or decision to publish the data in this manuscript.
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Dr. Dori receives research support from Siemens. Dr. Gillespie is a consultant for Medtronic. Doctors Glatz and Rome are consultants for Bristol Myers Squib Inc. The other authors have nothing to disclose.
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O’Byrne, M.L., Rome, N., Santamaria, R.W.L. et al. Intra-procedural Bronchoscopy to Prevent Bronchial Compression During Pulmonary Artery Stent Angioplasty. Pediatr Cardiol 37, 433–441 (2016). https://doi.org/10.1007/s00246-015-1296-0
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DOI: https://doi.org/10.1007/s00246-015-1296-0