A novel technique for stenting pulmonary artery and conduit bifurcation stenosis

Background: Distal conduit obstruction is a recognized complication after surgery for congenital heart disease requiring implantation of a conduit from the right ventricle to the pulmonary arteries. Endovascular stenting of distal conduit obstruction can be challenging due to the proximity to the pulmonary artery bifurcation. Objective: A technique is described, whereby a single stent is mounted onto two balloon angioplasty catheters in tandem. This ensemble was delivered to the distal conduit/pulmonary artery via a large Mullins sheath on two guidewires, one placed in each of the branch pulmonary arteries. The aim was to assess safety and efficacy of this novel technique. Materials and Results: Seven patients (mean age 13.4 (6.7–23.4) years, mean weight 44.2 (23–69) kg were treated with this method. The pressure gradient was reduced from 36 (26–52) mm Hg to 11 (8–15) mm Hg [P< 0.05]. RV/LV pressure ratio decreased from 0.85 (0.6–0.95) to 0.42 (0.35–0.5) [P < 0.05]. There were no significant complications. During follow‐up over a median of 2.6 (0.3–6.7) years no patient required re‐intervention or surgery. Conclusion: This novel technique appears to be safe and effective for stenting stenoses just proximal to pulmonary artery bifurcation. © 2011 Wiley‐Liss, Inc.