Impact of Pulmonary Artery Coarctation on Pulmonary Artery Growth and Definitive Repair Following Modified Blalock-Taussig Shunt

ABSTRACT: Objective Pulmonary artery coarctation (PACoA) may pose a risk for pulmonary stenosis and subsequent failure to achieve definitive repair. We sought to assess the impact of PACoA on pulmonary artery (PA) growth. Methods A retrospective chart review was performed in 130 patients, including 37 single ventricles with a modified Blalock-Taussig shunt (MBTS) as first palliation. PACoA was defined as discrete stenosis of the PA, with a diameter of less than 3 mm, and with the ductus arteriosus connected. Preoperative echocardiography showed PACoA in 29 patients (22%). Concomitant PA plasty was performed in 14 patients with discrete stenosis having a diameter of less than 2 mm. Results Pre-MBTS left PA z-scores were smaller in patients with PACoA than in those without (-4.0[-5.8, -2.1] vs. -1.7[-2.6, -0.8], p Conclusions PACoA affected disproportionate PA growth throughout the staged repair, but did not result in failure of definitive repair/Fontan completion. PA plasty during the neonatal period did not contribute to catch-up growth of the left PA; therefore, surgical indications and timing should be carefully considered.