Circulation, Vol 67, 962-967, Copyright © 1983 by American Heart Association
JE Lock, WR Castaneda-Zuniga, BP Fuhrman and JL Bass
Balloon dilation angioplasty (BDA) was attempted in seven children with
either stenosis or hypoplasia (a narrowing greater than 1 cm long extending
past the lung hilum) of both right and left pulmonary arteries (PAs). In
two of these seven, the procedure could not be performed because of
technical difficulties. In each of the remaining five children (1 1/2-16
years old), the right ventricular (RV) pressure was greater than 2/3 left
ventricular pressure, main PA pressure was greater than 60 mm Hg, and
previous operative attempts to relieve RV outflow obstruction, including
the branch PA obstruction, were unsuccessful. BDA was performed in only one
PA in each patient, and was considered successful if the pressure gradient
decreased, angiographic diameter increased and the percentage of blood flow
directed to the dilated lung increased. BDA was successful in all five
children: RV pressure fell from 104 +/- 42 to 80 +/- 30 mm Hg (p less than
0.05), the gradient across the obstruction fell from 61 +/- 51 to 32 +/- 22
mm Hg (p less than 0.05), the diameter of the narrowed segment increased
from 3.7 +/- 1.2 to 6.8 +/- 1.1 mm, p = 0.02), and the percentage of blood
flow (as determined by quantitative lung scan) to the dilated lung
increased from 41 +/- 16% to 52 +/- 22% (p less than 0.05). No morbidity
was observed in any patient. Follow-up angiograms (2-12 months) in three of
five patients indicate persistence of the anatomic improvement. While BDA
did not restore right-heart pressures and anatomy to normal, it provided
significant hemodynamic relief to a group of patients in whom traditional
operative management has usually been unsuccessful. Final determination of
the role of BDA in such patients must await the results of further studies.
ARTICLES
Balloon dilation angioplasty of hypoplastic and stenotic pulmonary arteries
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