Growth of the branch pulmonary arteries after employing ‘Shunt-only’ strategy for neonates with pulmonary atresia or stenosis

We sought to determine the impact of juxtaductal stenosis (JDS) on branch pulmonary artery (PA) growth after systemic-to-pulmonary shunt (SPS) placement without pulmonary arterioplasty (i.e. the ‘shunt-only’ strategy). This was a retrospective review of 91 patients, 54 (59.3%) with pulmonary atresia and 27 (29.7%) with a functionally single ventricle, who underwent neonatal SPS placement without pulmonary arterioplasty between 2008 and 2017. The median age and body weight at SPS procedure were 16 days (interquartile range [IQR], 11-22) and 3.10 kg (IQR: 2.85-3.40), respectively. All patients had pre-SPS computed tomography (CT) followed by post-SPS CT at a median interval of 5.8 months (IQR: 4.5-7.2). The ratio of the diameters of the juxtaductal PA over the non−SPS−side hilar PA (JD/PA) on preoperative CTa surrogate for JDS severitywas 0.93 (IQR: 0.67-1.09). The median diameter (Z) of the SPS−side and non−SPS-side PAs on postoperative CT were 1.0 (IQR: −0.07-1.73) and 0.99 (IQR: −0.45-1.70), respectively. The pulmonary artery index (Nakata index) increased significantly from 124.0 ± 50.2 mm2/m2 to 240.8 ± 88.7 mm2/m2 (P