Skip to main content Accessibility help

Stent treatment of ostial branch pulmonary artery stenosis: initial and medium-term outcomes and technical considerations to avoid and minimise stent malposition

  • Neil D. Patel (a1), Patrick M. Sullivan (a1), Cheryl M. Takao (a1), Sarah Badran (a1) and Frank F. Ing (a2)...



Stenting of ostial pulmonary artery stenosis presents several unique challenges. These include difficulty in defining anatomy and need for precise stent placement in order to avoid missing the ostial stenosis or jailing either the contralateral branch pulmonary artery or the ipsilateral upper lobe branch.


A retrospective review of outcomes was conducted in 1.5 or 2-ventricle patients who underwent stent placement for ostial branch pulmonary artery stenosis. Specific catheterisation lab techniques were reviewed.


Forty-seven branch pulmonary arteries underwent stent placement for ostial stenosis in 43 patients. The median age and weight were 3.7 (0.3–18.1) years and 14.2 (5.6–70.0) kg, respectively. Three (2–8) angiographic projections were needed to profile the ostial stenosis. Open-cell stents were used in 23 and stents were modified in 5 cases. Following stent implantation, the minimum diameter improved from 3.6 (0.8–10.5) to 8.1 (4.2–16.5) mm (p < 0.001). The gradient improved from 21 (0–66) to 4 (0–27) mmHg (p < 0.001). Stent malposition occurred in eight (17%) of the stents placed. Five migrated distally causing suboptimal ostial coverage necessitating placement of a second stent in four. Three migrated proximally and partially jailed the contralateral pulmonary artery. Intentional jailing of the upper lobe branch occurred in four additional cases. At a follow-up of 2.4 (0.3–4.9) years, 15 stents underwent further dilation and 1 had a second stent placed within the exiting stent.


Ostial branch pulmonary artery stenosis may require additional angiography to accurately define the ostial stenosis. Treatment with stents is effective but carries high rates of stent malposition.


Corresponding author

Author for correspondence: F. F. Ing, MD, Division of Pediatric Cardiology, UC Davis Children’s Hospital, 2516 Stockton Blvd, TICON II, Rm 208, Sacramento, CA95817, USA. Tel: +1 916 734 4262; Fax: +1 916 734 5533; E-mail:


Hide All
1.Baum, D, Khoury, GH, Ongley, PA, Swan, HJ, Kincaid, OW. Congenital stenosis of the pulmonary artery branches. Circulation 1964; 29: 680687.
2.Bacha, EA, Kreutzer, J.Comprehensive management of branch pulmonary artery stenosis. J Interv Cardiol 2001; 14: 367375.
3.Hwang, B, Lee, PC, Fu, YC, et al. Transcatheter implantation of intravascular stents for postoperative residual stenosis of peripheral pulmonary artery stenosis. Angiology 2004; 55: 493498.
4.Patel, ND, Kenny, D, Gonzalez, I, Amin, Z, Ilbawi, MN, Hijazi, ZM. Single-center outcome analysis comparing reintervention rates of surgical arterioplasty with stenting for branch pulmonary artery stenosis in a pediatric population. Pediatr Cardiol 2014; 35: 419422.
5.Moore, JW, Vincent, RN, Beekman, RH, et al. Procedural results and safety of common interventional procedures in congenital heart disease: initial report from the National Cardiovascular Data Registry. J Am Coll Cardiol 2014; 64: 24392451.
6.Lewis, MJ, Kennedy, KF, Ginns, J, et al. Procedural success and adverse events in pulmonary artery stenting: insights from the NCDR. J Am Coll Cardiol 2016; 67: 13271335.
7.Ing, FF, Khan, A, Kobayashi, D, Hagler, DJ, Forbes, TJ. Pulmonary artery stents in the recent era: immediate and intermediate follow-up. Catheter Cardiovasc Interv 2014; 84: 11231130.
8.Holzer, RJ, Gauvreau, K, Kreutzer, J, et al. Balloon angioplasty and stenting of branch pulmonary arteries: adverse events and procedural characteristics: results of a multi-institutional registry. Circ Cardiovasc Interv 2011; 4: 287296.
9.Law, MA, Shamszad, P, Nugent, AW, et al. Pulmonary artery stents: long-term follow-up. Catheter Cardiovasc Interv 2010; 75: 757764.
10.Gonzalez, I, Kenny, D, Slyder, S, Hijazi, ZM. Medium and long-term outcomes after bilateral pulmonary artery stenting in children and adults with congenital heart disease. Pediatr Cardiol 2013; 34: 179184.
11.Stanfill, R, Nykanen, DG, Osorio, S, Whalen, R, Burke, RP, Zahn, EM. Stent implantation is effective treatment of vascular stenosis in young infants with congenital heart disease: acute implantation and long-term follow-up results. Catheter Cardiovasc Interv 2008; 71: 831841.
12.Feltes, TF, Bacha, E, Beekman, RH, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation 2011; 123: 26072652.
13.Stapleton, GE, Hamzeh, R, Mullins, CE, et al. Simultaneous stent implantation to treat bifurcation stenoses in the pulmonary arteries: initial results and long-term follow up. Catheter Cardiovasc Interv 2009; 73: 557563.
14.Aldoss, O, Fonseca, BM, Truong, UT, et al. Diagnostic utility of three-dimensional rotational angiography in congenital cardiac catheterization. Pediatr Cardiol 2016; 37: 12111221.
15.Fagan, T, Kay, J, Carroll, J, Neubauer, A. 3-D guidance of complex pulmonary artery stent placement using reconstructed rotational angiography with live overlay. Catheter Cardiovasc Interv 2012; 79: 414421.
16.Goreczny, S, Dryzek, P, Morgan, GJ, Lukaszewski, M, Moll, JA, Moszura, T. Novel three-dimensional image fusion software to facilitate guidance of complex cardiac catheterization: 3D image fusion for interventions in CHD. Pediatr Cardiol 2017; 38: 11331142.
17.Sullivan, PM, Liou, A, Takao, C, et al. Tailoring stents to fit the anatomy of unique vascular stenoses in congenital heart disease. Catheter Cardiovasc Interv 2017; 90: 963971.
18.Travelli, FC, Sullivan, PM, Takao, C, Ing, FF. The Valeo stent: a pre-mounted, open-cell, large stent for use in small children with CHD. Cardiol Young 2016; 26: 11871193.
19.Boudjemline, Y, Legendre, A, Ladouceur, M, et al. Branch pulmonary artery jailing with a bare metal stent to anchor a transcatheter pulmonary valve in patients with patched large right ventricular outflow tract. Circ Cardiovasc Interv 2012; 5: e2225.


Related content

Powered by UNSILO

Stent treatment of ostial branch pulmonary artery stenosis: initial and medium-term outcomes and technical considerations to avoid and minimise stent malposition

  • Neil D. Patel (a1), Patrick M. Sullivan (a1), Cheryl M. Takao (a1), Sarah Badran (a1) and Frank F. Ing (a2)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.