Surgical Reconstruction of Peripheral Pulmonary Arteries: Strategies, Outcomes, and New Classification

Abstract

Pulmonary artery stenosis (PAS) is classified as central (types 1 and 2) and peripheral (type 3 affects proximal part of lobar arteries, type 4 affects proximal part of segmental arteries, and type 5 affects distal part of segmental arteries). In this study, we examine the outcomes of surgical reconstruction of peripheral PAS. We reviewed 31 patients with peripheral PAS who underwent surgical repair. Median age was 30months. Patients with intact ventricular septum (24patients) presented with severe right ventricular dilation and dysfunction and mean right ventricular to left ventricular pressure (RVSP/LVSP) ratio was 0.96 ± 0.25, 1.14 ± 0.23, and 1.43 ± 0.07 for types 3, 4, and 5, respectively (p= 0.03). Pulmonary artery reconstruction was achieved in single stage in 19 patients (61%). Six patients (19%) had type 3, 22 patients (71%) had type 4, and 3 patients (10%) had type 5. mean number of angioplasties per patient was 18 ± 8. There was no earlymortality. Mean postoperative RVSP/LVSP ratio decreased to 0.27 ± 0.08, 0.36 ± 0.05, and 0.96 ± 0.06, for types 3, 4, and 5, respectively (p < 0.001). The median follow-up was 48 months. Patients with type 3 and 4 showed marked improvement in functional status after surgery. Patients with type 5 showed clinical evidence of improved cardiac output despite modest decrease in RVSP. No surgical re-intervention was needed, while balloon dilation was performed in 1 patient with type 5 lesions. Surgical reconstruction of diffuse peripheral PAS is feasible and associated with excellent hemodynamic and functional outcomes in patients where there is no involvement of the distal part of segmental arteries.