ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2020, 5(4): 155–160
https://doi.org/10.26693/jmbs05.04.155
Clinical Medicine

Endovascular Methods of Treatment Pulmonary Artery Stenosis

Imanov E. 1, Truba Ya. 1, Pliska O. 2, Dzyurii I. 1, Sloboda A. 1, Lazoryshynets V. 1
Abstract

Pulmonary artery stenosis is a congenital heart defect that is characterized by a narrowing between the right ventricle and the pulmonary artery that carries blood to the lungs. It is possible to narrow directly pulmonary artery stenosis in its various parts. Most often this congenital disease occurs in children. Depending on the location of the area of narrowing (may occur at different levels) we can distinguish the following types of pulmonary artery stenosis: valve (narrowing of the valve of pulmonary artery stenosis), valvale (narrowing of the pulmonary artery stenosis trunk above the level of the valve), subscapular (infundibular, localized in the outflow tract and due to excessive growth of the muscles of the right ventricle, which impedes blood flow to the pulmonary artery stenosis), and peripheral stenoses of the pulmonary artery stenosis (stenoses of branches of the pulmonary artery itself, carrying blood to the right or left lung). In the structure of all the congenital heart defect, this defect is 3-9% of cases as isolated defect with the prevalence of this pathology in men is twice as high as in women. Pulmonary artery stenosis is often combined with other heart defects. The purpose of the work was to analyze the results of treatment of pulmonary artery stenosis in children by endovascular methods operated in the period from 2006 to 2019. Material and methods. For the period from 2006 to 2019, 102 consecutive patients with pulmonary artery stenosis were treated at the State Institution of the National Institute of Cardiovascular Surgery named after M. M. Amosov of the National Academy of Medical Sciences of Ukraine. Among them there were 51 female patients (50%) and 51 male patients (50%). The mean age of the patients was 123.8 ± 303.2 days (from 1 to 8 years), corresponding to a mean weight of 5.3 ± 2.7 kg. 31 (30.4%) patients had the prenatally diagnosed defect and confirmed it immediately after birth with the help of echocardiography. The diagnosis of pulmonary artery stenosis, taking into account the form, was made according to the results of the clinical examination and echocardiograms. As a result, we found out that 32% (33) patients had a valve variant of anomaly, and 68% (69) had pulmonary branch stenosis. Results and discussion. An uncomplicated postoperative course was observed in 49 (48%) patients who underwent surgery. The most frequent complications were respiratory failure, they were diagnosed in 23 (22.3%) cases, heart failure was detected in 25 (24.5%) cases and acute renal failure was diagnosed in 3 (3%) patients. In the postoperative period, 1 (1%) patients died as a result of progressive heart failure. It is necessary to indicate the patient's pre-serious condition is already admitted to the clinic. The only effective treatment for pulmonary artery stenosis is surgery. The choice of specific surgery depends on the localization of the narrowing: endovascular treatment (balloon valvuloplasty) can be applied only for valve and peripheral stenoses of branches of pulmonary artery. In other cases, open valvuloplasty, reconstructive plastic is performed (over-valve stenosis with the use of xenopericardial prosthesis or patch, infundibulectomy - with sub-valve stenosis). Conclusion. Pulmonary artery stenosis (valve form and stenosis of the branches of the pulmonary artery) are successfully treated with endovascular methods which reduce the operative trauma, the length of patients staying in hospital and increases their chances for positive consequences of surgery.

Keywords: pulmonary artery stenosis, endovascular treatment, balloon anhyoplasty, critical defect

Full text: PDF (Ukr) 208K

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