What is Repair of Pulmonary Artery Stenosis by Reconstruction with Patch or Graft?
Pulmonary artery stenosis is a narrowing of one or more of the pulmonary arteries in the lungs. It can be caused by a variety of conditions, including inflammation, infection, scarring, or congenital heart disease. It can lead to serious medical complications, such as difficulty breathing, lower blood oxygen levels, congestive heart failure, and even death.
Repair of pulmonary artery stenosis involves the reconstruction of the affected artery, either through a patch or graft. This treatment is typically used when other treatments, such as medications, lifestyle changes, or minimally invasive techniques, have failed to improve a patient’s pulmonary artery stenosis.
Repair of pulmonary artery stenosis with patch or graft reconstruction is a surgical procedure used to treat severe cases of pulmonary artery stenosis. During the procedure, an artery in the affected area is opened and either a patch or a graft is sewn into place so that blood can once again flow through the artery and restore normal blood pressure in the lungs.
The procedure is usually done by a cardiothoracic surgeon under general anesthesia. An incision is made in the chest wall, and any of the clots or scarring that are blocking the artery is removed. A patch or graft constructed from a prosthetic material (such as polytetrafluoroethylene, or PTFE) is then sewn into the area to reconstruct the artery.
The primary benefit of the repair of pulmonary artery stenosis by reconstruction with a patch or graft is improved blood flow through the lungs. This makes it easier for the heart to pump blood, reduces the risk of further complications to the heart and other organs, and can improve symptoms of shortness of breath, chest pain, and fatigue.
In addition, the procedure can reduce the risk of death from pulmonary artery stenosis, as it can restore normal blood pressure and proper blood flow through the lungs.
The results of repair of pulmonary artery stenosis reconstruction with a patch or graft are typically positive. Most patients can expect improved blood flow and reduced symptoms of pulmonary artery stenosis. The risk of further complications is also reduced.
That said, the outcome of the procedure depends on the severity of the illness, the precise location of the stenosis in the pulmonary artery, the type of patch or graft used, and the skill of the medical team. The risks of the procedure include bleeding, infection, and a reaction to the anesthesia.
Repair of pulmonary artery stenosis reconstruction with a patch or graft is an invasive procedure that carries significant risks. Patients should always discuss the risks and benefits of the procedure with their cardiothoracic surgeon and get a clear understanding of the expected results before they make their decision.
In some cases, an alternative course of action may be preferable. This could include medications, lifestyle changes, or minimally invasive procedures to reduce the symptoms of pulmonary artery stenosis instead of reconstruction with a patch or graft.
Repair of pulmonary artery stenosis reconstruction with a patch or graft is a surgical procedure used for severe cases of pulmonary artery stenosis that have not responded to other treatments. The procedure can improve blood flow through the affected artery and reduce the risk of serious complications. That said, it carries serious risks, and patients should discuss all of their treatment options with their cardiothoracic surgeon.
Definition & Overview
Pulmonary artery stenosis is the narrowing of the pulmonary artery, a major artery that brings deoxygenated blood from the heart to the lungs. When this artery is blocked, the blood flow is disrupted and the blood gets less oxygen. This is the reason why patients with the condition have bluish skin colour. They also experience fatigue, breathlessness, and chest pain. Unless they seek treatment, the condition can cause serious health problems that can eventually lead to death.
The repair of a narrowed pulmonary artery using different techniques aims to widen the arterial wall to restore normal blood flow.
Who Should Undergo and Expected Results?
The methods used to treat pulmonary artery stenosis depend on the severity of the condition. Mild blockage can be treated using medications. However, if the narrowing is more than 50%, minimally invasive surgical procedures are considered. Typically, patients with this condition suffer from the following symptoms:
- Shortness of breath
- Rapid heart rate
- Heavy or rapid breathing
- Swelling in the abdomen, ankles, feet, and eyelids
To determine the best treatment for the patient, doctors perform various diagnostic procedures to properly assess the severity of the condition. These tests may include electrocardiography (ECG), chest x-ray, echocardiography (producing an echocardiogram), and/or cardiac MRI (magnetic resonance imaging).
How is the Procedure Performed?
The type of treatment for pulmonary artery stenosis depends on the severity of the condition. As mentioned above, mild stenosis can be treated with medications while severe cases may require a procedure called balloon valvuloplasty.
In a balloon valvuloplasty, a catheter is inserted in the vein located in the groin. The catheter is passed through the heart’s right ventricle and positioned to the area where the narrowing is identified. Once there, the catheter inflates the balloon, opening the artery in the process. As it increases in size, the narrowed area is stretched and widened. When the correct width is achieved, the balloon is deflated and the catheter is withdrawn.
In repairing pulmonary stenosis, a patch or a graft that is made of human tissue is used to widen the pulmonary valve in case it is very small. This is useful when the obstruction is not due to any blood clot but caused by thickened muscle tissue usually below the pulmonary valve.
A valve is a membranous structure with tissue flaps that open and close in response to pressure. Their primary function is to ensure that the flow of liquid only goes to a single direction. This means that any liquid that passes through it toward a certain direction will not flow back.
Normally, this procedure only applies to the pulmonary area. But in cases where doctors also identify a need to widen the blood vessels leading to the heart’s right ventricle, a transannular patch (a patch across the pulmonary valve connective tissue) is used. This technique covers the wall of the right ventricle as well as treats or widens the pulmonary valve and the pulmonary artery.
Oftentimes, a procedure called cardiac catheterisation is performed to establish exactly the degree of blockage of the passageway. This is done by measuring the difference in blood pressure between the pulmonary artery and the right ventricle.
Possible Risks and Complications
The risks involved in the repair of pulmonary artery stenosis are small because it is minimally invasive. The procedure is also not complicated and usually lasts an hour or less depending on the severity of the condition.
Follow-up is required for most patients especially those who have a severe case of pulmonary artery stenosis. Regular testing will also need to be done to catch early symptoms of recurrence.
Some patients may need to take antibiotic maintenance to avoid any infection to the internal lining of the heart called bacterial endocarditis. This is done to prevent any infections during and after the procedure.
Physical activity can be resumed provided the surgeon has approved the level of activity the patient plans to take. The patient will have to stop any form of physical activity once symptoms, such as chest pain and breathlessness, manifest.
The procedure is also safe for pregnant women, as it does not cause any damage to the foetus. However, surgeons recommend that any signs of stenosis are treated and repaired before pregnancy to avoid any complications that might affect the baby in the womb during and after the procedure. This is because pregnant women with pulmonary artery stenosis have a high risk of developing atrial arrhythmias (abnormal heartbeat) and heart failure.
Despite the risk, balloon valvuloplasty can be performed on pregnant women with less risk to the foetus.
Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008 Dec 2. 118(23):e714-833.
Shaath G, Mutairi MA, Tamimi O, Alakhfash A, Abolfotouh M, Alhabshan F. Predictors of re-intervention in neonates with critical pulmonary stenosis or pulmonary atresia with intact ventricular septum. Catheter Cardiovasc Interv. 2011 Sep 27.