Endovascular stent implantation to relieve extrinsic right pulmonary artery compression due to an enlarged neoaorta

Pulmonary Artery Stenosis in Tetralogy of Fallot

Tetralogy of Fallot (TOF) is the most common cyanotic congenital cardiac defect. The survival rate after primary complete repair is high (98-100%); however, pulmonary artery stenosis (PAS) is not uncommon after TOF repair, and severe PAS aggravates pulmonary regurgitation, resulting in right ventricle dilation, ventricular arrhythmia, and possibly death. PAS in TOF can be congenital due to hypoplasia or coarctation or can be acquired secondary to a surgical procedure. The latter may be caused by an exogenous conduit implant, compression from the adjacent enlarged ascending aorta, or outflow tract dilation after transannular patch repair. PAS can also be caused by the pulmonary artery plasty strategy itself. Here, the intrinsic mechanisms underlying PAS and pulmonary artery plasty techniques and strategies are reviewed to provide guidance for surgeons.

Transcatheter techniques in the management of perioperative vascular obstruction

The role of transcatheter intervention for the treatment of vascular obstruction is well documented in the preoperative or remote postoperative settings. More recently, the roles of angioplasty and stent implantation have been advocated as intraoperative and immediate postoperative strategies. As one considers the inherent advantages in this cooperative approach to congenital heart disease, the development of a truly hybrid interventional suite seems imperative.

Interventional strategies in the management of peripheral pulmonary artery stenosis

Peripheral pulmonary artery stenosis challenges therapeutic algorithms for the management of congenital heart malformations. Surgical repair of the proximal pulmonary artery lesion remains with a high recurrence rate while the distal lesions are difficult to access. With the development of transcatheter interventional strategies in the early 1980s, a number of transcatheter treatment options became available. In this review, we summarize the current state of the art for interventional strategies in the management of peripheral pulmonary artery stenosis.

Percutaneous stenting of bilateral pulmonary artery stenosis caused by malignant extrinsic compression

Percutaneous stenting of the pulmonary arteries (PAs) represents a potential option in cases of PA compression due to a variety of conditions. We present the first reported case of successful bilateral percutaneous stenting of the PAs in a patient with non-small cell lung cancer and severe right ventricular hypertension due to mediastinal lymphadenopathy compressing both PAs. Although the natural course of the disease was not altered, the patient had significant symptomatic relief without adverse effects. Additionally, there was objective evidence of improvement. This case suggests that endovascular stenting is a feasible palliative management option in patients with right ventricular failure due to malignant extrinsic compression of the PAs.