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Eur J Cardiothorac Surg 1999;14:229-234
© 1999 Elsevier Science NL

Pulmonary artery stenosis after systemic-to-pulmonary shunt operations

^a Department of Thoracic and Cardiovascular Surgery, Klinik für Thorax-, Herz- und Gefäßchirurgie, Universitätsklinikum, Pauwelsstraße 30, 52057 Aachen, Germany
^b Department of Pediatric Cardiology, Kinderkardiologische Klinik, Universitätsklinikum, Pauwelsstraße 30, 52057 Aachen, Germany

Received 14 April 1998; received in revised form 9 June 1998; accepted 16 June 1998.

Corresponding author. Department of Thoracic and Cardiovascular Surgery, University Hospital, Pauwelsstrasse 30, D-52057 Aachen, Germany. Tel.: +49 241 8089957/14151; fax: +49 241 8888454

Objective: Systemic-to-pulmonary shunt operations are still required for palliation of certain congenital heart defects. The aim of this study was to analyze the incidence and etiology of the development of pulmonary artery stenosis after these procedures. Methods and results: Pre- and post-operative angiograms of 59 patients who underwent 54 peripheral and 12 central shunt operations were analyzed retrospectively. Patients without prior cardiovascular interventions (group I, n=47) were differentiated from patients with prior interventions (group II, n=12). In group I, all peripheral shunts were inserted contralaterally to the ductus arteriosus. Follow-up for all patients was 1.8 years (4 days–7.8 years). Pulmonary artery stenosis was diagnosed in 12/59 patients (20.3%, group I 12/47; group II 0) after a time interval of 4 days up to 5.3 years and only after Blalock–Taussig shunts (one classical, 11 modified) (12/40=30%). The stenoses were located ipsilaterally to the shunt in 7/12 and contralaterally in 5/12. Statistical analysis did not show any impact of age, weight, sex, shunt type or size, pulmonary artery diameters, Nakata and McGoon indices and prior interventions on the development of pulmonary artery stenosis. However, a patent ductus arteriosus and administration of Prostaglandin E₁ had a significant impact on the development of pulmonary artery stenosis on the side of the ductus arteriosus. Conclusion: Pulmonary artery stenosis is not a rare event after systemic-to-pulmonary shunt operations. A patent ductus arteriosus with or without administration of Prostaglandin E₁ is related to pulmonary artery stenosis on the side of the ductus arteriosus. Pulmonary artery stenosis on the side of a peripheral shunt may be caused by inappropriate surgical technique, increased intimal proliferation, or pulmonary artery kinking. Treatment depends on severity of cyanosis and on further surgical plans.

Key Words: Systemic-to-pulmonary shunt operation • Congenital heart disease • Pulmonary artery stenosis • Heart surgery