Cutting balloon angioplasty on branch pulmonary artery stenosis in pediatric patients

Catheter Cardiovasc Interv. 2021 Sep;98(3):526-532. doi: 10.1002/ccd.29803. Epub 2021 Jun 10.


Objectives: To identify medium-term results following cutting balloon angioplasty (CBA) for branch pulmonary artery stenosis (PAS) and predictors of successful intervention.

Background: CBA has emerged as a successful alternative therapy for PAS resistant to conventional balloon angioplasty techniques but there is little information on medium and long-term outcomes.

Methods: This is a descriptive, single center, retrospective chart review of pediatric patients who underwent CBA for PAS at Arkansas Children's Hospital between May 2005 and December 2020. We reviewed demographics, procedural specifics, and 30-day complications.

Results: Forty-four patients underwent pulmonary artery CBA on 114 pulmonary artery segments through 126 catheterization cases, totaling 148 CBA events. Thirty-three individual pulmonary arteries underwent repeat intervention. Average minimal luminal diameter increase from pre-CBA to end of follow-up was 57% (CI, 38%-75%). Absence of Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries (TOF/PA/MAPCAs) and the absence of Alagille Syndrome, Williams Syndrome, or Arterial Tortuosity Syndrome (ATS) were associated with increased odds of sustained success by 70% (CI, 0.11-0.79) and 91% (CI, 0.02-0.56), respectively. Increasing the cutting balloon diameter-to-minimal luminal diameter ratio by 0.5 increased odds of successful intervention by 2.37-fold (CI, 1.7-3.3). Seven patients had 30-day complications including one death.

Conclusions: In the longest follow-up to date of children and adolescents who underwent CBA for branch PAS, we found that there was moderate medium-term success. Additionally, absence of TOF/PA/MAPCAs, absence of Alagille Syndrome, Williams Syndrome, or ATS, and high cutting balloon diameter-to-minimal luminal diameter ratio are predictors of sustained results.

Keywords: Alagille; Williams; pediatric; tetralogy of Fallot.

MeSH terms

  • Adolescent
  • Angioplasty, Balloon* / adverse effects
  • Child
  • Humans
  • Pulmonary Artery / diagnostic imaging
  • Pulmonary Artery / surgery
  • Pulmonary Atresia*
  • Retrospective Studies
  • Stenosis, Pulmonary Artery* / diagnostic imaging
  • Stenosis, Pulmonary Artery* / etiology
  • Tetralogy of Fallot*
  • Treatment Outcome