Balloon Angioplasty of Pulmonary Artery Following Arterial Switch Operation for Complete Transposition of the Great Arteries

Summary

Twenty-eight patients with transposition of the great arteries underwent 39 balloon angioplasty procedures after the arterial switch operation. The mean age at dilation was 4.5 years (range, 0.7–10 years). The mean interval between operation and balloon dilation was 3.6 years. The criterion of successful dilation was an increase of 50% or greater in the predilation diameter or a decrease of 50% or greater in the predilation pressure gradient. The success rate of balloon angioplasty for pulmonary artery stenosis was 51%. The interval between operation and dilation in the successful dilation group was significantly less than that in the unsuccessful dilation group. In 13 patients who underwent balloon angioplasty less than 3.5 years after operation, balloon dilation was successful in 92%. A balloon-to-artery ratio of more than 2.3 was necessary to dilate the stenotic segment. There were no deaths, but one pulmonary artery rupture, which did not require surgical intervention, occurred. Aneurysmal dilation of the pulmonary artery was observed in 3 patients. These data indicate that although the success rate of balloon angioplasty for pulmonary artery stenosis after the arterial switch operation is modest (50%), balloon angioplasty can be the first therapeutic choice owing to the low complication rate and the potential benefit of the procedure. The success rate can be high if angioplasty is performed less than 3.5 years after operation and a balloon of adequate size is used.