chapter  12
22 Pages

Stenting branch pulmonary arteries

WithFrank F Ing

Stent-implantation to treat a branch pulmonary stenosis in congenital heart disease is well established.1-9

While its safety and efficacy is well reported in the literature, the procedure can be quite challenging technically and fraught with anatomic limitations, adverse events and complications. Anatomic limitations of this procedure may include small patient size and lack of vascular access due to obstructed femoral veins secondary to prolonged central line placement and/or repeated access previously. Furthermore, anatomy of the pulmonary artery stenosis may be quite varied and complex, and difficult to navigate, especially in the presence of a dilated right atrium and right ventricle. Associated regurgitant tricuspid and/or pulmonary valves also add to the difficulty of maintaining adequate wire control during the stenting procedure. Complex anatomy may include stenosis adjacent to side branches, especially the lobar and segmental branches.10-11 Noncompliant, long segmental stenosis may pose a particular challenge, even if access is adequate.