Endovascular
stent implantation for
pulmonary artery stenosis requires the use of a long, large-bore vascular sheath to insure precise implantation without embolization or malposition. A long vascular sheath may be difficult to position and usage may be associated with vascular compromise and/or hemodynamic embarrassment, especially in infants and small children. We report a new technique for pulmonary artery endovascular
stent implantation without the use of a long sheath. From December 2000 to May 2001, 10 patients underwent implantation of 13 Palmaz Corinthian premounted biliary transhepatic
stents for
pulmonary artery stenosis. Median age was 0.8 years (range, 0.5-18.5) and median weight was 11.8 kg (range, 4.6-65). Patient diagnoses were
tetralogy of Fallot (five),
double outlet right ventricle (three), branch peripheral
pulmonary artery stenosis (two), single ventricle s/p
cavopulmonary shunt (one), and truncus arteriosus (one). All Palmaz Corinthian
stents were delivered uncovered on Cordis Opta LP balloon
catheters via short sheaths (6-7 Fr); super-stiff guidewires were not always necessary. These
stents, with a maximal expanded diameter of 12 mm, were placed for peripheral
pulmonary artery stenosis as a definitive procedure or at the pulmonary artery bifurcation in patients who were expected to undergo future open heart surgery. The
stents were initially implanted on 4, 6, or 8 mm balloon
catheters and further expanded if needed.
Stents were placed in the right pulmonary artery alone in three patients, left pulmonary artery alone in four patients, and side-by-side
stents were implanted simultaneously in three patients. All thirteen
stents were implanted successfully in the desired location without
stent malposition or embolization. Mean angiographic diameter increased from 2.5 +/- 1.5 to 5.7 +/- 1.4 mm (P < 0.01) and peak systolic ejection gradients decreased from 44 +/- 22 to 14 +/- 11.6 mm Hg (P < 0.01). The uncovered delivery of the premounted Palmaz Corinthian
stent allowed for precise and safe endovascular
stent implantation without the hemodynamic and technical problems associated with long vascular sheath usage. This technique is useful for the palliation of proximal
pulmonary artery stenosis and is effective definitive treatment for peripheral
pulmonary artery stenosis in small infants and children.