Pulmonary Artery Angioplasty (Main Pulmonary Artery Rotation Flap Technique) in Tetralogy of Fallot Patients With Acute-Angle Branch Pulmonary Artery Stenosis

Abstract

Despite excellent outcomes of tetralogy of Fallot (TOF) repair, reinterventions for recurrent or residual stenosis of branch pulmonary arteries are still required in many patients. The development of these lesions may be related to 2 inherent characteristic morphologies of TOF: Pulmonary ductal coarctation and acute angulation of branch pulmonary artery, especially the left pulmonary artery. I developed a main pulmonary artery rotation flap angioplasty technique to deal with acute-angle branch pulmonary artery stenosis without using any patch. Since 1998, 68 TOF patients have undergone this technique. During a median follow-up of 13.5 years, 20 (29%) patients underwent catheter or surgical-based intervention for branch pulmonary stenosis. Overall freedom from any intervention was 87%, 76%, 70%, and 59% at 1-year, 5-year, 10-year, and 20-year periods, respectively. I believe that this technique is reproducible and provides excellent intermediate and long-term outcomes in TOF patients with complicated branch pulmonary artery stenosis. Despite excellent outcomes of tetralogy of Fallot (TOF) repair, reinterventions for recurrent or residual stenosis of branch pulmonary arteries are still required in many patients. The development of these lesions may be related to 2 inherent characteristic morphologies of TOF: Pulmonary ductal coarctation and acute angulation of branch pulmonary artery, especially the left pulmonary artery. I developed a main pulmonary artery rotation flap angioplasty technique to deal with acute-angle branch pulmonary artery stenosis without using any patch. Since 1998, 68 TOF patients have undergone this technique. During a median follow-up of 13.5 years, 20 (29%) patients underwent catheter or surgical-based intervention for branch pulmonary stenosis. Overall freedom from any intervention was 87%, 76%, 70%, and 59% at 1-year, 5-year, 10-year, and 20-year periods, respectively. I believe that this technique is reproducible and provides excellent intermediate and long-term outcomes in TOF patients with complicated branch pulmonary artery stenosis.