Abstract

ObjectivePulmonary flow restrictors (PFRs) are interesting devices, but their surgical removal outcomes are poorly understood. MethodsRetrospective review of clinical data from children with bilateral PFRs who underwent device removal during follow-up surgery. ResultsThirty-four PFRs were explanted from 17 patients (41.2% males) at a median of 2 months (IQR, 1.2-5.2) post-implantation, with a median patient age of 2.5 months (IQR, 1.6-5.8). One patient experienced life-threatening bilateral pulmonary artery (PA) aneurysms two months after PFR implantation, necessitating urgent surgery. Two PFRs were found migrated across left PA's upper lobe branch origin. Twenty-six were removed intact, 1 in two fragments, and 7 piecemeal. No thrombus was noted. Neoendothelium was observed on 11 PFRs. Seven PFRs caused endothelial damage, requiring sharp and blunt dissection for removal. Six right and four left PA arteriotomies were patched. Hegar dilators, with median sizes of 7 mm (IQR, 6.8-8.3) for right PA and 7 mm (IQR, 7-8) for left PA, confirmed branch patency. At a median follow-up of 14.8 months (IQR, 10.2–18.3), echocardiographic maximum velocities in 13 biventricular patients and 2 awaiting future biventricular repair were 1.5m/s (IQR, 1.4–1.7) for the left PA and 1.6m/s (IQR, 1.4–1.7) for the right PA. One patient with deferred Norwood had normal PAs and well-positioned PFRs on pre-stage-II catheterization. A patient who underwent stage-II Norwood 3.2 months post-PFR implantation died from sepsis 1 month later, but post-Glenn angiogram revealed no stenosis. ConclusionsPFR removal is safe and effective. Complications are manageable, with no PA stenosis observed.

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