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. 1998 Jan;79(1):24–28. doi: 10.1136/hrt.79.1.24

Percutaneous treatment of stenosed major aortopulmonary collaterals with balloon dilatation and stenting: what can be achieved?

S Brown 1, B Eyskens 1, L Mertens 1, M Dumoulin 1, M Gewillig 1
PMCID: PMC1728562  PMID: 9505914

Abstract

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.
Objective—To evaluate balloon dilatation and stenting for relief of stenoses and improvement of pulmonary flow in patients with PA-VSD.
Design—Retrospective analysis of all patients where dilatation of MAPCA stenoses was attempted.
Patients—Twelve patients with stenotic MAPCAs.
Interventions—Dilatation 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 measures—Diameter of stenoses before and after dilatation as well as arterial oxygen saturation data. Patients proceeding to surgical therapy.
Results—Two 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.
Conclusions—Pulmonary 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.

 Keywords: major aortopulmonary collateral arteries;  pulmonary atresia and ventricular septal defect;  angioplasty;  stenting;  interventional cardiology

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Figure 1  .

Figure 1  

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Example of MAPCA stenosis resistant to 20 atm. Notice the remaining waist of balloon (no dilatation at site of stenosis).

Figure 2  .

Figure 2  

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Change in diameter where partial balloon expansion was achieved (n = 5) and complete balloon dilatation (BD) (n = 6) before and after dilatation.

Figure 3  .

Figure 3  

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Increase in diameter of MAPCA stenoses before and after stenting.    

Figure 4  .

Figure 4  

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Angiogram (aortogram (A) and selective injection (B)) of a stenotic MAPCA perfusing the left upper lobe and lingula; note the poor peripheral perfusion. (C) Balloon dilatation: 6 mm balloon with complete disappearance of the waist. (D) Selective angiogram of the stenotic MAPCA after dilatation: there is better distal perfusion, aortic saturation had increased from 68% to 80% and distal mean pressure increased from 12 to 30 mm Hg.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Haworth S. G. Collateral arteries in pulmonary atresia with ventricular septal defect. A precarious blood supply. Br Heart J. 1980 Jul;44(1):5–13. doi: 10.1136/hrt.44.1.5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Haworth S. G., Macartney F. J. Growth and development of pulmonary circulation in pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries. Br Heart J. 1980 Jul;44(1):14–24. doi: 10.1136/hrt.44.1.14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Haworth S. G., Rees P. G., Taylor J. F., Macartney F. J., de Leval M., Stark J. Pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries. Effect of systemic pulmonary anastomosis. Br Heart J. 1981 Feb;45(2):133–141. doi: 10.1136/hrt.45.2.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hofbeck M., Sunnegårdh J. T., Burrows P. E., Moes C. A., Lightfoot N., Williams W. G., Trusler G. A., Freedom R. M. Analysis of survival in patients with pulmonic valve atresia and ventricular septal defect. Am J Cardiol. 1991 Apr 1;67(8):737–743. doi: 10.1016/0002-9149(91)90532-p. [DOI] [PubMed] [Google Scholar]
  5. Kates M. A., Jenkins J. S., Shaw D., Karsan A. K., Hebert L. P., Collins T. J., Ramee S. T. Endovascular stenting for treatment of an adult patient with pulmonary artery stenosis with 1-year follow-up. Cathet Cardiovasc Diagn. 1996 Aug;38(4):417–420. doi: 10.1002/(SICI)1097-0304(199608)38:4<417::AID-CCD21>3.0.CO;2-A. [DOI] [PubMed] [Google Scholar]
  6. Moussa I., Di Mario C., Di Francesco L., Reimers B., Blengino S., Colombo A. Subacute stent thrombosis and the anticoagulation controversy: changes in drug therapy, operator technique, and the impact of intravascular ultrasound. Am J Cardiol. 1996 Aug 14;78(3A):13–17. doi: 10.1016/s0002-9149(96)00486-9. [DOI] [PubMed] [Google Scholar]
  7. O'Laughlin M. P., Perry S. B., Lock J. E., Mullins C. E. Use of endovascular stents in congenital heart disease. Circulation. 1991 Jun;83(6):1923–1939. doi: 10.1161/01.cir.83.6.1923. [DOI] [PubMed] [Google Scholar]
  8. Rabinovitch M., Herrera-deLeon V., Castaneda A. R., Reid L. Growth and development of the pulmonary vascular bed in patients with tetralogy of Fallot with or without pulmonary atresia. Circulation. 1981 Dec;64(6):1234–1249. doi: 10.1161/01.cir.64.6.1234. [DOI] [PubMed] [Google Scholar]
  9. Ramsay J. M., Macartney F. J., Haworth S. G. Tetralogy of Fallot with major aortopulmonary collateral arteries. Br Heart J. 1985 Feb;53(2):167–172. doi: 10.1136/hrt.53.2.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Reddy V. M., Liddicoat J. R., Hanley F. L. Midline one-stage complete unifocalization and repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals. J Thorac Cardiovasc Surg. 1995 May;109(5):832–845. doi: 10.1016/S0022-5223(95)70305-5. [DOI] [PubMed] [Google Scholar]
  11. Redington A. N., Somerville J. Stenting of aortopulmonary collaterals in complex pulmonary atresia. Circulation. 1996 Nov 15;94(10):2479–2484. doi: 10.1161/01.cir.94.10.2479. [DOI] [PubMed] [Google Scholar]
  12. Rome J. J., Mayer J. E., Castaneda A. R., Lock J. E. Tetralogy of Fallot with pulmonary atresia. Rehabilitation of diminutive pulmonary arteries. Circulation. 1993 Oct;88(4 Pt 1):1691–1698. doi: 10.1161/01.cir.88.4.1691. [DOI] [PubMed] [Google Scholar]
  13. Shanley C. J., Lupinetti F. M., Shah N. L., Beekman R. H., 3rd, Crowley D. C., Bove E. L. Primary unifocalization for the absence of intrapericardial pulmonary arteries in the neonate. J Thorac Cardiovasc Surg. 1993 Aug;106(2):237–247. [PubMed] [Google Scholar]
  14. Shimazaki Y., Iio M., Nakano S., Morimoto S., Ikawa S., Matsuda H., Kawashima Y. Pulmonary artery morphology and hemodynamics in pulmonic valve atresia with ventricular septal defect before and after repair. Am J Cardiol. 1991 Apr 1;67(8):744–748. doi: 10.1016/0002-9149(91)90533-q. [DOI] [PubMed] [Google Scholar]
  15. Thiene G., Frescura C., Bini R. M., Valente M., Gallucci V. Histology of pulmonary arterial supply in pulmonary atresia with ventricular septal defect. Circulation. 1979 Nov;60(5):1066–1074. doi: 10.1161/01.cir.60.5.1066. [DOI] [PubMed] [Google Scholar]

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