Contralateral Pulmonary Hypertension Following Resuscitation of Unilateral Ductal Origin of a Pulmonary Artery

A Multi-institutional Review

Hitesh Agrawal, Christopher J. Petit, Joaquim Miro, Carlos D. Miranda, Damien Kenny, Henri Justino

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

In isolated unilateral ductal origin of a pulmonary artery (DOPA), intervention to establish reperfusion of the affected lung without direct re-anastomosis may lead to pulmonary hypertension (PH) in the contralateral lung. Multicenter retrospective review of patients with unilateral DOPA, who underwent palliation with a ductal stent (DS) or Blalock–Taussig (BT) shunt with subsequent development of PH in the contralateral lung, was conducted. Ten patients (4 females; median weight 3.2 kg, range 2.1–5.2) who underwent DS or BT shunt and developed contralateral PH were identified. Eight infants had right-sided DOPA. Stents/shunt used had a median diameter of 3.5 mm (range 2.5–5.2). After DS in 9 patients, 7 patients were exclusively treated with medical therapies, whereas 2 patients received intermediate procedures: one received an additional contralateral DS and other underwent surgical banding of the DS prior to PA reimplantation. Seven patients who underwent DS and one patient with BT shunt underwent PA reimplantation at median of 3.3 (0.6–18) months. PA pressure was documented to be normal in 5 patients immediately following PA reimplantation, 1 year later in 2 patients, and 1 patient is on Tadalafil with elevated PVR of 5.5 indexed Wood units. One patient died and one patient is awaiting surgery with normal PA pressure. We describe the development of severe contralateral PH following DS or BT shunt as the initial intervention for unilateral DOPA. Pulmonary hypertension resolved in 7/8 patients who underwent surgical PA reimplantation. The cause of PH in the normally connected lung in these cases remains unclear.

Original languageEnglish (US)
Pages (from-to)71-78
Number of pages8
JournalPediatric Cardiology
Volume39
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Pulmonary Hypertension
Resuscitation
Pulmonary Artery
Stents
Replantation
Lung
Pressure
Reperfusion
Weights and Measures

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

Cite this

Contralateral Pulmonary Hypertension Following Resuscitation of Unilateral Ductal Origin of a Pulmonary Artery : A Multi-institutional Review. / Agrawal, Hitesh; Petit, Christopher J.; Miro, Joaquim; Miranda, Carlos D.; Kenny, Damien; Justino, Henri.

In: Pediatric Cardiology, Vol. 39, No. 1, 01.01.2018, p. 71-78.

Research output: Contribution to journalArticle

Agrawal, Hitesh ; Petit, Christopher J. ; Miro, Joaquim ; Miranda, Carlos D. ; Kenny, Damien ; Justino, Henri. / Contralateral Pulmonary Hypertension Following Resuscitation of Unilateral Ductal Origin of a Pulmonary Artery : A Multi-institutional Review. In: Pediatric Cardiology. 2018 ; Vol. 39, No. 1. pp. 71-78.
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