Open Access

ARTICLE

Pulmonary artery interventions after the arterial switch operation: Unique and significant risks

by

Department of Pediatric Cardiology, Rady Children’s Hospital, University of California San Diego, San Diego, California

* Corresponding Author: Jesse Lee, MD, Department of Pediatric Cardiology, Rady Children’s Hospital, University of California San Diego, San Diego, CA 92123. Email:

Congenital Heart Disease 2019, 14(2), 288-296. https://doi.org/10.1111/chd.12726

Abstract

Background: In the modern era, results of the arterial switch operation (ASO) for transposition of the great arteries are excellent. However, because of the LeCompte maneuver, there may be a propensity for development of pulmonary artery stenosis. We encountered atypical complications of pulmonary artery stenting in patients after the ASO, including aorto‐pulmonary fistula and coronary compression.
Methods: We performed a 10‐year retrospective review of catheterizations per‐ formed in patients after ASO in our institution with a focus on adverse events.
Results: Diagnostic and interventional catheterizations were performed in 47 pa‐ tients. In 29 patients, 37 interventional procedures performed, which included pul‐ monary artery angioplasty and/or stenting. In this group, there were five major adverse events (14%), including three aorto‐pulmonary fistulae and one coronary artery compression among patients having stent implantation or stent redilation. In addition, there were 6/37 (16%) intended stent procedures, which were aborted be‐ cause there appeared to be high‐risk of significant adverse events.
Conclusions: This review suggests that percutaneous intervention on pulmonary ar‐ tery stenosis after ASO has high‐risk and should be undertaken advisedly. Prior thor‐ ough evaluation of coronary arteries is mandatory as coronary reimplantation sites may be adjacent to sites of pulmonary artery stenosis. Furthermore, if pulmonary artery stent implantation or stent redilation is contemplated, the risk of stent fracture and possible AP fistula should be recognized. Primary use of reinforced covered stents should be considered.

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