Cutting balloon angioplasty for children with small-vessel pulmonary artery stenoses

Patients with complex congenital heart disease may have pulmonary artery stenoses that are either congenital or associated with scarring following surgical procedures. This study evaluates cutting balloon angioplasty for small-vessel pulmonary artery stenoses resistant to standard balloon angioplasty. Between October 1998 and December 1999, patients were enrolled in an FDA-approved compassionate-use protocol. During four catheterizations, there were seven lesions found resistant to standard balloon angioplasty (mean lesion diameter was unchanged: 1.8 mm +/- 0.8 mm to 1.9 +/- 0.8 mm). A cutting balloon was inflated twice in each of these lesions. Standard balloon angioplasty was then repeated. Final mean lesion diameter was increased significantly (1.9 mm +/- 0.8 mm to 3.8 +/- 1.3 mm; P <or= 0.01). Follow-up catheterizations performed a median of 14 months later showed only slight decrease in mean lesion diameter (3.2 +/- 1.2 mm), still significantly greater than initial mean lesion diameter (P < 0.03). In conclusion, cutting balloon angioplasty for pulmonary artery stenoses resistant to standard balloon angioplasty improves the immediate and intermediate term results of angioplasty for these lesions.