Oval stenting in left pulmonary artery stenosis: a novel double balloon technique to prevent airway compression in single ventricle.

AIMS: Left pulmonary artery (LPA) stenosis is common in patients with cavopulmonary connections. Stent implantation is the treatment of choice, but may be complicated or contra-indicated by left main bronchus (LMB) compression due to limited retro-aortic space after Damus-Kaye-Stansel (DKS) or Norwood operation. This study describes a novel double balloon technique of LPA stenting in patients at risk for LMB compression. METHODS AND
RESULTS: A cohort study was performed in 11 patients who underwent LPA stenting with oval stent technique between 2015 and 2018. Retro-aortic anatomy was evaluated peri-procedural by three-dimensional rotational angiography (3DRA). Pre-existing LMB compression was demonstrated by 3DRA in 7 out of 8 patients who underwent previous LPA stenting and in one patient without stent. Primary ovalization with immediate stent implantation on double balloons was performed in one patient. Ten patients had secondary ovalization with single balloon stent implantation followed by double balloon technique for ovalization. The procedures were successful in all patients and guaranteed LMB patency without increasing pre-existing compression.
CONCLUSIONS: The 3DRA guided oval stent technique with double balloon inflation is successful to treat LPA stenosis after DKS or Norwood operation in patients at risk for bronchial compression, guaranteeing LMB patency without increasing pre-existing compression.