Pulmonary Artery Selective Catheterization Through Surgically Created Systemic to Pulmonary Shunt

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Abstract

Background and objectives

The assessment of the anatomy, pressure and resistance of the pulmonary artery is an essential part of pre-operative evaluation of patients with cyanotic congenital heart disease. When antegrade passage of a catheter into the pulmonary artery is not possible, it is preferable to measure directly the pulmonary pressure, pulmonary vascular resistance and perform angiography by catheterization of the surgically created shunt.

Method and results

We used this method successfully in 43 consecutive patients with a mean age of 5 years (range 4 months to 33 years). The patients had the following diagnoses: Fallot's tetralogy (n = 9), pulmonary atresia with a ventricular septal defect (n = 8), pulmonary atresia with an intact ventricular septum (n = 8), tricuspid atresia (n = 7), transposition of the great vessels with pulmonary stenosis or atresia (n = 6), critical pulmonary stenosis (n = 1) and single ventricle with pulmonary atresia (n= 4). We were able to detect left pulmonary stenosis (n=9),right pulmonary stenosis(n= 3), distortion of a pulmonary artery caused by the shunt (n'= 6), pulmonary artery hypoplasia (n = 9) and disconnection of pulmonary branches (n= 2).Five patients had stenosis and 2 had occlusion of the anastomosis. Three patients underwent successful balloon dilation.

Conclusions

Selective catheterization of surgically created systemic to pulmonary shunt is a safe method to provide, direct access to the pulmonary vascular bed as well as accurate information for planning the conective surgery in these patients.