Pulmonary artery growth after palliation of congenital heart disease with duct-dependent pulmonary circulation: arterial duct stenting versus surgical shunt.

Objectives The aim of this study was to compare the pulmonary artery (PA) growth after arterial duct (AD) stenting versus modified Blalock-Taussig shunt (MBTS) in neonates with congenital heart disease with duct-dependent pulmonary circulation (CHD-DPC). Background Arterial duct stenting is increasingly deemed a reliable alternative to surgical shunt in CHD-DPC. A stented duct might better adapt to the PA anatomy than a surgical conduit, thereby promoting a more uniform PA development. Methods This study enrolled 27 patients with CHD-DPC submitted to AD stenting (n * 13, Group I) or MBTS (n * 14, Group II) at our institution. The PA growth was angiographically assessed with the Nakata and McGoon indexes as well as the individual PA z-scores. The right-to-left PA diameter ratio was considered as index of uniform growth. Results After 10 * 5 months, both options had promoted a significant increase of the Nakata index (from 136 * 72 mm/m2 to 294 * 99 mm/m2, p * 0.0001, Group I; from 151 * 74 mm/m2 to 295 * 177 mm/m2, p * 0.003, Group II) and McGoon ratio (from 1.5 * 0.3 to 2.1 * 0.3, p * 0.0001, Group I; from 1.6 * 0.3 to 2.0 * 0.5, p * 0.01, Group II). However, the surgical shunt had caused a worsening of the left-to-right PA diameter ratio compared with AD stenting (0.9 * 0.1 Group I vs. 1.6 * 0.9 Group II, p * 0.01), due to preferential growth of the PA contralateral to the shunt. Conclusions Percutaneous AD stenting is as effective as MBTS in promoting a global PA growth in CHD-DPC. In addition, it ensures an even distribution of the pulmonary blood flow, thereby promoting a more balanced pulmonary vascular development than MBTS. (J Am Coll Cardiol 2009;54:2180–6) © 2009 by the American College of Cardiology Foundation