Ratio Of Pulmonary Artery Diameter Research Articles

Prognostic value of pulmonary artery diameter/aorta diameter ratio in patients with acute pulmonary embolism.

The ratio of pulmonary artery diameter (PAD) to ascending aortic diameter (AoD) has been reported to be aprognostic marker in several lung diseases; however, the usefulness of this tool in patients with acute pulmonary embolism (APE) is unknown. Here, we aimed to determine the long-term prognostic value of the PAD/AoD ratio in patients with APE. Atotal of 275 patients diagnosed with APE at our tertiary care center between November 2016 and February 2022 were included in the study. The patients were divided into two groups according to the presence of long-term mortality and their PAD/AoD ratios were compared. Long-term mortality was observed in 48patients during the median follow-up of 59(39-73) months. The patients were divided into two groups for analysis: group1, consisting of 227 patients without recorded mortality, and group2, consisting of 48patients with documented mortality. A multivariate Cox regression model indicated that the PAD/AoD ratio has the potential to predict long-term mortality (HR:2.9116, 95% CI: 1.1544-7.3436, p = 0.023). Analysis of the receiver operating characteristic curve revealed that there was no discernible difference in discriminative ability between the simplified pulmonary embolism severity index (sPESI) and PAD/AoD ratio (area under the curve [AUC] = 0.679 vs. 0.684, respectively, p = 0.937). The long-term predictive ability of the PAD/AoD ratio was not inferior to the sPESI score. The PAD/AoD ratio, which can be easily calculated from pulmonary computed tomography, may be auseful parameter for determining the prognosis of APE patients.

Novel Noninvasive Index Combining Echocardiography and Computed Tomography for Screening Pulmonary Hypertension in Systemic Sclerosis

BackgroundIn patients with systemic sclerosis (SSc), early detection of pulmonary hypertension (PH) improves survival. This study aimed to investigate whether combining index of tricuspid regurgitation jet peak gradient (TRPG) and the ratio of pulmonary artery diameter to aortic diameter measured by computed tomography (PA ratio) (cPAT) can estimate mPAP and detect PH more accurately than conventional parameters in SSc patients. MethodsThirty-six SSc patients who underwent PH screening were retrospectively analyzed. All patients were screened for PH between 2013 and 2017 by echocardiography, computed tomography, and right heart catheterization (RHC). Patients with mPAP > 20mmHg by RHC were diagnosed as PH. Additionally, patients with mPAP > 20mmHg, PVR > 2 wood unit, and PAWP ≤ 15mmHg and ruled out other causes including group 2-5 were defined as pulmonary atrial hypertension (PAH). ResultsOf 36 patients, 29 patients were female (81%) and the average duration of SSc was 7.5 years. The mPAP was significantly correlated with TRPG (r = 0.734), PA ratio (r = 0.584), and cPAT (r = 0.848). In ROC analysis to identify PH, cPAT showed the highest area under the curve of 0.906 among the three parameters. Additionally, in ROC analysis to identify PAH, cPAT also showed the highest area under the curve of 0.851 among the three parameters. ConclusionCPAT is a new index combining echocardiogram and CT that provides the most accurate non-invasive assessment of mPAP in SSc patients. cPAT can also help detect PH early in SSC, thereby allowing for earlier treatment.

Pulmonary artery diameter ratio as a prognostic indicator of congenital diaphragmatic hernia

BackgroundFollowing on from an earlier study published in 2008 about left pulmonary artery (LPA) flow measured on serial echocardiography being strongly prognostic in left-sided congenital diaphragmatic hernia (CDH) and the...

Prognostic Utility of the Ratio of Pulmonary Artery Diameter to Ascending Aorta Diameter in COVID-19 Patients

Prognostic Utility of the Ratio of Pulmonary Artery Diameter to Ascending Aorta Diameter in COVID-19 Patients

CT measured pulmonary artery to ascending aorta ratio stratified by echocardiographically obtained systolic pulmonary artery pressure values for noninvasive detection of pulmonary hypertension in patients with severe aortic valve stenosis.

Transthoracic echocardiography (TTE) offers a measurement method for the determination of pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) with determination of maximal tricuspid regurgitation velocity (TRVmax) and systolic pulmonary artery pressure (sPAP). Radiological parameters for noninvasive detection of PH, most importantly computed tomography (CT) based PA/AA-ratio = ratio of pulmonary artery diameter (PA) and ascending aorta diameter (AA), are also included in the latest ESC guidelines. The aim of the present study was to define cut-off values for PA/AA-ratio taking also into account cardiovascular biomarkers to determine criteria for noninvasive diagnosis of PH. 194 patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) underwent pre-procedural TTE and CT with measurement of PA/AA-ratio. Additionally, common cardiovascular biomarkers were determined. TAVR patients with an sPAP ≥ 40mmHg or a TRVmax ≥ 2.9m/s had a PA/AA-ratio ≥ 0.80 in an AUROC analysis. The cut-off value of ≥ 0.80 resulted in a significantly higher mortality rate (log-rank test: p = 0.034) in these patients in a Kaplan-Meier analysis regarding 1-year survival after TAVR. Significant differences in biomarker expression between patients with a PA/AA-ratio ≥ 0.80 or < 0.80 occurred for BNP (p = 0.001), cTnI (p = 0.032), GDF-15 (p = 0.002) and H-FABP (p = 0.015). PA/AA-ratio ≥ 0.80 is a promising radiological parameter that can provide information about mortality in patients with severe AS undergoing TAVR; combined with biomarkers it may contribute to noninvasive detection of PH in patients with severe AS.

Validity of the Ratio of Pulmonary Artery Diameter to Aortic Diameter in the Diagnosis of Pulmonary Embolism in the Emergency Department

Background: Pulmonary thromboembolism can be easily diagnosed with computed tomography (CT) and pulmonary angiography (CTPA). However, diagnosis is difficult since a contrast agent cannot be used. Several criteria are recommended for the diagnosis of pulmonary embolism (PE) with non-enhanced CT. Objectives: The aim of this study is to investigate the value of the increase in the pulmonary artery diameter (PA-D) and the ratio of the pulmonary artery diameter / ascending aorta diameter (Ao-D) ratio (PA-D/Ao-D) in the diagnosis of PE in the emergency department (ED). Methods: The CTPA of patients diagnosed with PE (n=88) and a control group (n=89) were examined retrospectively. The main PA (MPA), right MPA (RMPA), left MPA (LMPA), and Ao-D were measured. The ratio of PA-D and Ao-D was calculated. Results: Mean age of participants of this study was 67.85±17.03 (Min:18, Max:98) in the PE group and 67.31±20.17 (Min:20, Max:91) in the control group (P=0.272). The PE diagnosis of RMPA, right segmental PA, and right subsegmental PA were found to be more than the left side. Moreover, the mean D-Dimer levels were found to be higher in the PE group (7.31±3.528 mcg/L), compared to the control group (1.52±1.042 mcg/L) (P=0.000). In the PE group, the mean Ao-D (35.14±4.55 mm) was larger, compared to the control group (34.97±5.28 mm); however, it was not statistically significant (P=0,828). In the PE group, the average MPA diameter (MPA-D) (30.45±4.77 mm) was larger than that of the control group (28.35±3.81 mm) and statistically significant (P=0,001). In addition, in the PE group, the average MPA-D/Ao-D ratio (0.87±0.15) was higher in comparison to the control group (0.82±0.13) (P=0,016). Conclusion: The increase in PA-D and PA-D/Ao-D ratio can be used in the diagnosis of PE when contrast agent cannot be given on CT or when thrombus cannot be seen on CT for the diagnosis of PE in the ED.

Ratio of Pulmonary Artery Diameter to Ascending Aortic Diameter as a Predictive Tool for Severe Primary Graft Dysfunction in Heart Transplants

The Ratio of pulmonary artery diameter to ascending aortic diameter (PA:Ao ratio) on computed tomography (CT) is a recent predictive tool known to be associated with severity of heart failure and right heart failure after left ventricular assist device implantation. We searched for a predictive use of PA:Ao ratio in heart transplanted patients METHODS: We collected extensive data from heart transplanted patients in our institution from 2012 to 2018. The diameters of the ascending aorta and the pulmonary artery were defined as the diameter at the level of the artery pulmonary bifurcation in a transaxial slice. Patients were separated into two groups: those with a PA:Ao ratio <1 and those with a PA:Ao ratio >1. We compared the incidence of severe primary graft dysfunction and early ICU death between these two groups. Secondary endpoint was the rate of high pulmonary vascular resistance in both groups. Between 2012 and 2018, 144 consecutive patients were heart transplanted. 50 had a PA:Ao ratio >1 (34,7%) and 94 had a PA:Ao ratio <1 (65,2%). Incidence of severe primary graft dysfunction was significantly higher in patients who had larger pulmonary arteries (48% Vs 15,9% p< 0,0001), mortality in ICU however did not differ (16% Vs 13,8%, p=0,919). Pulmonary vascular resistance superior to 2 woods was significantly associated with PA:Ao Ratio >1 compared to PA:Ao Ratio <1 (54% Vs 37,2 % p=0,047) but was less predictive for severe PGD (38,6% Vs 48% p=0, 246). PA:Ao ratio is a robust tool for prediction of severe primary graft failure in heart transplantation. Further studies should explore our findings for external validation.

Primary Central Pulmonary Artery Plasty for Ductal-Associated Pulmonary Artery Coarctation

Infants with functionally single ventricle who require a modified Blalock-Taussig shunt can have stenosis at the ductal insertion site on the pulmonary artery (PA), the so-called ductal-associated PA coarctation. We hypothesized that central PA plasty with resection of the ductal tissue on the PA during the first palliation would prevent PA coarctation and obtain well-balanced PA for Fontan operation. We performed this strategy on 40 consecutive patients (from 1998 to 2012, Age 38.4 ± 24.7 day [17 neonates], body weight 3.5 ± 0.8 kg, heterotaxy n = 27). The mean Nakata index (mm2/m2) before bidirectional cavopulmonary shunt was 230.7 ± 101.7 without pulmonary stenosis. The PA diameter ratio and lung perfusion ratio (nonshunt side and/or shunt side) were 0.93 ± 0.25 and 0.9 ± 0.2, respectively. This strategy may improve clinical outcomes on functional single ventricle patients with increased risk of stenosis from pulmonary coarctation, with avoidance of an unbalanced pulmonary vascular bed.

Clinical outcome and survival in 30 pulmonary hypertension patients with high severity indices and advanced functional class.

ABSTRACTBACKGROUND: Pulmonary hypertension (PH) is an idiopathic or secondary disorder associated with many systemic illnesses. Long-term survival in PH depends on the severity and functional class. Several new drugs are now available to treat PH, but their impact on clinical outcome and survival are not well established.OBJECTIVES: Evaluate severity parameters and the impact of current recommended therapy on survival in PH.DESIGN: Cross-sectional.SETTINGS: Tertiary care center.PATIENTS AND METHODS: The study included adult patients who had undergone right heart catheterization since 2012 and were diagnosed with pulmonary hypertension. Survival was recorded after 6 years, at the end of the study. Nine severity variables for PH were assessed including right ventricular size by echocardiogram and pulmonary artery diameter (PA diameter) and the ratio of pulmonary artery diameter to ascending aorta diameter (PA/Ao ratio) by CT.MAIN OUTCOME MEASURES: Evaluation of severity parameters.SAMPLE SIZE: 30 patients.RESULTS: Twenty-five patients were positive for 8/9 severity parameters. Eight of 30 (26.6%) patients died. In nonsurvivors, right ventricular size was increased by 25% (P=.427), pulmonary vascular resistance increased by 29.4% in nonsurvivors (P=.302), the 6-minute walk distance decreased by 21% (P=.875), median brain natriuretic peptide increased by 96% (P=.890), median GGT and alkaline phosphatase were 3 times higher in nonsurvivors (P=.893 and P=.047, respectively) and PA/Ao was nonsignificantly decreased in nonsurvivors (P=.373), Survival was decreased by a median of 2.3 years in nonsurvivors.CONCLUSION: Our study identified a subgroup of PH patients with NYHA functional class III and above with worsening severity indicators who were labeled as a high-risk group. These patients showed continuous deterioration in their clinical status despite escalation of therapy with current guidelines. We recommend these high-risk group patients be referred for early lung transplantation.LIMITATIONS: Low sample size and only a single center. Needs confirmation with a larger multicenter trial.CONFLICT OF INTEREST: None.

Prenatal and postnatal ultrasound assessment and clinical prognostic analysis for Ebstein anomaly

Objective: To investigate the echocardiographic features of fetal Ebstein's anomaly (EA) and to analyze its clinical outcome and prognosis. Methods: A retrospective case-control study was conducted to analyze the echocardiographic features in fetus with EA. Thirty-five EA fetuses (EA group) and 35 normal fetuses matched for gestational age (control group) were enrolled. The main echocardiographic parameters of the two groups were collected and compared. According to the direction of blood flow in the ductus arteriosus (DA),fetuses in EA group were divided into DA reverse perfusion subgroup (n=11) and normal DA blood flow subgroup (n=24). The echocardiographic parameters and GOSE scores were compared between the two subgroups. The echocardiographic features of EA and the difference of fetal hemodynamics were summarized,and the clinical outcome of EA fetus was evaluated by GOSE score. Chi-square test Rank sum test or t test were used for comparison between groups. Results: Nineteen (54%) of the 35 patients terminated the pregnancy and 16 (46%) continued pregnancy until delivery during follow-up. Compared with the normal fetus group,the cardiothoracic ratio was significantly higher (0.47±0.11 vs. 0.34±0.01, t=6.640, P<0.01) and the transverse diameter ratio of right atrium to left atrium was significantly greater (1.42±0.38 vs. 1.08±0.11, t=5.030, P<0.01) in the EA group, and the ratio of pulmonary artery diameter to aortic diameter was significantly lower in the EA group (1.04±0.21 vs. 1.20±0.15, t=-3.770, P<0.01). Compared with the normal DA blood flow subgroup,the GOSE scores ≥ 1.5 was more frequently seen (7/11 vs. 3/24, P=0.004) and the ratio of pulmonary artery diameter to aortic diameter was significantly lower (0.91±0.18 vs. 1.24±0.20, t=-4.696, P=0.002) in the DA reverse perfusion subgroup. Six of the 16 delivery cases underwent EA corrective surgery after birth with 100% successful rate of operation. Among the 6 cases,two had preoperative GOSE score of ≥1.5 who were considered as severe cases,and four had low GOSE score of<1.5. The remaining ten cases who had not undergone the corrective surgery were followed up routinely. Conclusion: Prenatal hemodynamics of EA combined with GOSE score can more accurately evaluate the severity and prognosis of fetal EA, reduce unnecessary labor induction, and improve postpartum cure rate and clinical outcomes.

Ratio of pulmonary artery diameter to ascending aortic diameter and severity of heart failure.

Treatment decisions in dilated cardiomyopathy (DCM) patients with severe heart failure (HF) and short clinical history are challenging because of the difficulty of determining HF stage or prognosis in the acute HF phase. We hypothesized that persistent decreased systemic or increased pulmonary arterial pressure, including in the sub-clinical phase, might affect the main pulmonary artery diameter (PAD), ascending aortic diameter (AoD), and their ratio (PAD/AoD). This study assessed AoD, PAD, and PAD/AoD by non-contrast computed tomography scans in DCM patients in the acute phase of HF and examined the association of these parameters with their clinical course. Of 261 screened individuals, we studied 110 consecutive hospitalized patients with DCM suspected of being in advanced stage of HF and 45 age-matched controls, assessing clinical data and later events (cardiac death or left ventricular assist device implantation). Compared with controls, DCM patients had smaller AoD (26.6 ± 4.4 vs 30.6 ± 2.7 mm) and larger PAD (27.7 ± 3.5 vs 25.4 ± 2.8 mm) and PAD/AoD (1.05 ± 0.14 vs 0.83 ± 0.08; all p < 0.01). DCM patients with high PAD/AoD (median, > 1.05) had more frequent past HF hospitalizations, lower blood pressure, stroke volume, and ejection fraction, higher brain natriuretic peptide levels, smaller AoD, and similar PAD compared with patients with a low PAD/AoD. A higher PAD/AoD was associated with poorer outcomes even after adjusting for age, blood pressure, ejection fraction, or number of hospitalizations. Assessment of AoD and PAD may have important clinical implications in determining whether DCM patients are in an advanced stage of HF with a poorer prognosis.

A scoring system to predict the elevation of mean pulmonary arterial pressure in idiopathic pulmonary fibrosis.

Elevated mean pulmonary arterial pressure (MPAP; ≥21 mmHg) is sometimes seen in patients with idiopathic pulmonary fibrosis (IPF) and has an adverse impact upon survival. Although early diagnosis is crucial, there is no established screening tool that uses a combination of noninvasive examinations.We retrospectively analysed IPF patients at initial evaluation from April 2007 to July 2015 and, using logistic regression analysis, created a screening tool to identify elevated MPAP. Internal validation was also assessed for external validity using a bootstrap method.Using right-heart catheterisation (RHC), elevation of MPAP was determined to be present in 55 out of 273 patients. Multivariate models demonstrated that % predicted diffusing capacity of the lung for carbon monoxide (DLCO) <50%, ratio of pulmonary artery diameter to aorta diameter (PA/Ao) on computed tomography (CT) ≥0.9 and arterial oxygen tension (PaO2 ) <80 Torr were independent predictors. When we assigned a single point to each variable, the prevalence of elevation of MPAP with a score of zero, one, two or three points was 6.7%, 16.0%, 29.1% and 65.4%, respectively. The area under curve (AUC) for the receiver operating characteristic (ROC) curve was good at 0.757 (95% CI 0.682-0.833).A simple clinical scoring system consisting of % predicted DLCO, PA/Ao ratio on CT and PaO2 can easily predict elevation of MPAP in patients with IPF.

Influences of Anesthetics in term of Computed Tomography Bronchial Lumen to Pulmonary Artery Diameter Ratio in Beagle Dogs

Influences of Anesthetics in term of Computed Tomography Bronchial Lumen to Pulmonary Artery Diameter Ratio in Beagle Dogs

Ten-years, single-center experience with arterial duct stenting in duct-dependent pulmonary circulation: early results, learning-curve changes, and mid-term outcome.

To evaluate early results, learning-curve changes, and mid-term outcome of arterial duct (AD) stenting in congenital heart disease with duct-dependent pulmonary circulation (CHD-DPC) in a high-volume, tertiary referral center. In spite of wide acceptance as cost-effective alternative to surgical palliation, AD stenting indications, results and mid-term outcome still largely depend on small series, experiences in particular subsets of patients or multicenter series with different approaches and interventional philosophy. Between April 2003 and December 2013, 119 patients underwent AD stenting as lower-risk palliation of CHD-DPC at our Institution. Procedural and mid-term follow-up data of these patients are reported. The procedure was successfully completed in 93.3% of cases, with a complication rate and in-hospital mortality of 17.6% and 3.6%, respectively. No patient underwent rescue surgical shunt but elective Blalock-Taussig shunt was needed in 15 patients (13.5%). Over time, favorable trends toward higher feasibility and efficacy in complex ductal anatomy as well as lower procedural risk were recorded. Presurgical cardiac catheterization (n = 36) showed significant and balanced pulmonary artery (PA) growth (Nakata Index +113 ± 101%; left PA z-score +87 ± 52%; right PA z-score +97 ± 53%, P < 0.001 for all comparisons), without significant changes of left-to-right PA diameter ratio. PA growth was significantly better in patients with severely hypoplastic PAs at the time of duct stabilization (Nakata Index increase 194 ± 115 vs. 75 ± 61%, P < 0.001). AD stenting is feasible and effective at low-risk in a high percentage of patients with CHD-DPC, promoting significant and balanced PA growth mainly in patients with hypoplastic main PAs at duct stabilization.

Primary Central Pulmonary Artery Plasty for Single Ventricle With Ductal-Associated Pulmonary Artery Coarctation

Infants with a single ventricle who require a modified Blalock-Taussig shunt can have stenosis at the ductal insertion site on the pulmonary artery (PA). We hypothesized that primary PA plasty in the first palliation would limit PA stenosis and unbalanced pulmonary perfusion, and thereby facilitate safe accomplishment of the next operation. From 1998 to 2012, functional single-ventricle patients with pulmonary atresia were managed as follows: initial operative strategy based on midline approach, using cardiopulmonary bypass, and central PA plasty (resection of all ductal tissue). All patients underwent catheter study and lung perfusion test before bidirectional cavopulmonary shunt (BCPS). Forty consecutive patients (heterotaxy, n = 27; others, n = 13) were enrolled in this study. Seven patients (17.5%) had repair of obstructed total anomalous pulmonary venous drainage, and 4 (10%) had repair of common atrioventricular valve at the first palliative operation. Fifteen patients (37.5%) underwent first palliation in the neonatal period. The mean PA index (mm(2)/m(2)) before BCPS was 230.7 ± 101.7. No pulmonary stenosis was detected before BCPS. Pulmonary artery diameter ratio (nonshunt side/shunt side) was 0.93 ± 0.25; pulmonary lung perfusion ratio (nonshunt side/shunt side) was 0.9 ± 0.2. A multivariate analysis identified persistent total anomalous pulmonary venous drainage (extracardiac type; p = 0.002) as a factor associated with unbalanced branch pulmonary arteries at BCPS. Thirty-five patients underwent BCPS, and 31 underwent Fontan procedures. There were 4 early deaths and 4 late deaths. The strategies we have employed facilitate safe accomplishment of the next-stage operation in diverse anatomic groups, with avoidance of unbalanced pulmonary vascular bed.

Pulmonary Hypoplasia Associated with Congenital Heart Diseases: A Fetal Study

BackgroundAbnormalities of the fetal pulmonary vasculature may affect lung morphogenesis. Postnatal studies have suggested that pulmonary hypoplasia (PH) may be associated with congenital heart diseases (CHDs).ObjectiveTo determine the prevalence of PH associated with CHDs, and to evaluate whether CHDs with right outflow obstruction were associated with the highest risk of lung growth impairment.MethodsBetween January 2006 and December 2010, fetuses with CHD obtained following the termination of pregnancies due to fetal abnormalities were examined in a prospective manner for the detection of heart and lung defects. CHDs were classified into five pathophysiological groups. Lung weight (LW), body weight (BW), and LW/BW ratio were analyzed for each case. The expression of CD31 and VEGF in the lung was evaluated by immunohistochemistry.ResultsFetuses with CHDs and right outflow obstruction had significantly lower LW for a given BW, and significantly lower LW/BW ratios for a given gestational age. When defining PH as a fetal LW/BW ratio <0.015 before 28 weeks, and <0.012 after 28 weeks, PH was detected in 15 of the 119 fetuses analyzed (13%). It was significantly associated with CHD with right outflow obstruction, independently of chromosomal abnormalities and associated extracardiac abnormalities (p<0.03). Right outflow obstruction was detected in 60% of the fetuses with CHD and PH, but in only 32% of those with CHD but no PH. In fetuses with right outflow obstruction, no difference was observed between those with PH and those without PH, in terms of the ratio of pulmonary artery diameter to aortic diameter, lung CD31 expression, or lung VEGF expression.ConclusionCHDs with right outflow obstruction are a significant risk factor for prenatally acquired PH. The occurrence of fetal PH is not correlated with abnormalities of the pulmonary vasculature, suggesting the involvement of perfusion-independent mechanisms.

Pulmonary artery growth following arterial duct stenting in congenital heart disease with duct‐dependent pulmonary circulation

The aim of this study was to assess the pulmonary artery (PA) growth following arterial duct (AD) stenting in neonates with congenital heart disease (CHD) with duct-dependent pulmonary circulation. AD stenting is increasingly deemed as a reliable alternative to surgical shunt in CHD with duct-dependent pulmonary circulation. Allowing the stent to conform to the PA anatomy might avoid any unbalance of lung perfusion and promote a uniform growth of the main PAs. Of the 47 neonates and infants submitted to AD stenting as palliation of CHD with duct-dependent pulmonary circulation at our Institution, 15 underwent angiographic evaluation of the PA development before surgical repair due to progressive decrease of the systemic oxygen saturation. The Nakata and McGoon indexes as well as the left-to-right PA diameter ratio were considered as being indicative of global and balanced growth. Ductal stabilization was achieved with coronary stents dilated to 3.3 + or - 0.4 mm (range 2.5-4). The control angiography was performed 7 + or - 3 months (range 3-13) after the stenting procedure. At that time, the Nakata and McGoon indexes had significantly increased from 132 + or - 67 to 287 + or - 94 mm/m(2) and from 1.6 + or - 0.3 to 2.1 + or - 0.2 mm/m(2), respectively (P < 0.0001 for both comparisons), due to uniform vascular growth (left PA z-score from -0.7 + or - 1.6 to 1.4 + or - 1.2; right PA from -0.8 + or - 1.4 to 1.4 + or - 1.2, P < 0.0001 for both comparisons; final left-to-right PA ratio 0.9 + or - 0.1). Percutaneous AD stabilization with highly flexible coronary stents is effective in promoting a significant and balanced growth of the PAs in CHD with duct-dependent pulmonary circulation.