408:
the balloon folds, ensuring they will not accidentally damage other vessels. After the use of the cutting balloon, a larger, higher-pressure balloon can be used to improve efficacy. Multicenter studies reported the same safety profiles for simple versus cutting, with adverse effect rates of 2% and 3%, respectively. When a high-pressure balloon was used after cutting balloon angioplasty the rate of effectiveness increased from 52% to 85%. Cutting balloon angioplasty provides more areas of vessel damage especially in vessels further from the heart. Overall cutting balloon angioplasty has similar complications and restenosis rates as simple, but offers a more effective treatment, and is a better option for smaller areas.
64:
40:
388:, and areas of narrowing due to compression by another body part rather than issues with the vessel itself. Even given evidence of vessel wall tearing, the rate of restenosis is between 15 and 44%. Studies reported that the rate of restenosis increases as time from the procedure increases. Rates of complications overall are estimated around 22%, including 10% higher risk complications. Other complications from this procedure are likely from too much vessel damage and include full vessel tears,
440:
Another concern is fracturing, or breaking, due to repetitive pressure. Patients experience a 13% adverse event rate with major events such as a fracture at 1.2%. Studies reported that the adverse event rate decreased with patient age, likely due to less growth in the vessel. Replacement rates are as
407:
Cutting balloon angioplasty was invented to help reduce vessel damage. This method utilizes balloons with a blade that can cut through vessel walls rather than simply causing vessel wall tearing via crushing/expansion of the balloon. When the balloon is not inflated the blades are protected inside
449:
Prior to the development of balloon angioplasty, surgical angioplasty was the main treatment method. Because of lack of efficacy, limited accessibility to certain areas of stenosis, increased risk for scarring, and a high rate of repeat stenosis, surgical angioplasty is only used if other methods
420:
are deployed via catheter. They are expanded at the site. The stents form a rigid structure that remain at the site. Newer studies reported successful dilation in 90% of patients on average, with newer studies indicating a 100% success rate. The benefits of stents is long term efficacy and the
110:
to the pulmonary artery and toward the lungs. Oxygenated blood returns to the left side of the heart before it is pumped throughout the body. When the pulmonary artery narrows, it increases blood pressure on the right side of the heart and causes the heart to work harder.
425:. Stents improved right side heart pressures, blood flow to the lungs, and pressure difference between the right and left sides. Stents can last up to 15 years, much longer than balloon angioplasty. Stents have the lowest rate of restenosis, at 2-3%.
450:
fail or if surgeons observe the narrowing while repairing another defect. Some studies reported a 62% surgical success rate for surgical angioplasty. Alternative treatments would be required for 4/10 patients while exposing them to risks of surgery.
118:. The pulmonary valve is the opening between the right heart and the pulmonary artery. Valve narrowing has similar effects. However, treatment is different. The long term consequences of each condition also vary and present with other comorbidities.
359:
Balloon angioplasty expands the diameter of a vessel to counter narrowing. In this treatment a catheter with a balloon on the end is inserted into a larger, peripheral vessel and moved to the narrowing site. The goal is to tear two of the three
453:
Initially a soft balloon was used, but only about 60% of patients experienced even a 50% increase in blood flow. This efficacy was similar to surgical angioplasty with a large risk reduction. Later, a stiffer balloon achieved better results,
231:: aorta and pulmonary artery swap where they receive blood from. Blood from the left side enters the pulmonary artery and goes to the lungs instead of the body while unoxygenated blood from the right side goes to the body.
432:
or vasculature. 30-50% of young children required replacement with a larger stent in the first 2 years of placement. Complication rates are around 12% and include drift due to blood flow, which can damage vessels,
765:
750:
95:, newborns, and young children. The more severe the disease the more likely it is to present with symptoms. With high-risk patients, it is necessary and acceptable to actively treat, to avoid worsening
241:
connects the pulmonary artery and aorta before and just after birth. In this condition the ductus does not shrink and close but remains open and causes extra blood to flow into the lungs and left side.
172:
When blood cannot reach the lungs because of the narrowing, blood can back up. This can lead to swelling in body parts such as the hands and feet and can present similarly to right sided
191:: obstruction in blood leaving the right side of the heart, enlargement in the lower right chamber, an opening between the right and left lower chambers of the heart, and mispositioned
102:
Blood flows in a methodical way through the body. Blood that has already delivered oxygen returns to the heart. It arrives at the right upper chamber, gets pumped though the
91:
The narrowing can occur at many points along the pulmonary artery. The specific location indicates severity and affects treatment options. Most people with high-risk PAS are
437:
formation on the stent. Because of these concerns and necessary removal of the stent if these were to occur, the stent must be monitored frequently after placement.
508:
Patel, Anuj B.; Ratnayaka, Kanishka; Bergersen, Lisa (2019). "A review: Percutaneous pulmonary artery stenosis therapy: State-of-the-art and look to the future".
819:
551:
293:
There is no immediate way to know if a child has PAS, but abnormal heart sounds, also known as murmurs, heard on physical exam, dictate further testing.
602:
Kim, Chan W.; Aronow, Wilbert S.; Dutta, Tanya; Spevack, Daniel M.; Frishman, William H. (2021). "Treatment of
Peripheral Pulmonary Artery Stenosis".
184:
Although 40% of individuals have no other underlying heart problems, PAS can still occur in 2-3% of individuals with congenital heart disease:
318:: a series of x-rays creates a detailed view of the heart and vessels. Using contrast dye can allow visualization of blood flow and narrowing.
84:
moving blood from the right side of the heart to the lungs. This narrowing can be due to many causes, including infection during pregnancy, a
1021:
399:
Younger patients are typically treated with balloon angioplasty until they are older and the risk for metal stents is significantly reduced.
17:
1017:
812:
380:
location of the narrowing, as vessels further from the heart are more elastic and more difficult to treat with balloon angioplasty.
364:, which increases the vessel's diameter and blood flow. A relatively stiff balloon achieves 72% efficacy with no risk increase.
1013:
1070:
805:
225:: a hole between the right and left lower chambers allowing blood from the left, higher pressure side, to enter the right.
1049:
995:
228:
990:
658:
126:
Pulmonary artery stenosis symptoms depend on the location and cause of the narrowing. Common symptoms include:
893:
201:: pulmonary valve does not form, and blood is unable to travel from the right side of the heart to the lungs.
474:
300:(EKG): electrical recording of the heart that can show irregular heartbeats and changes in the heart muscle.
272:: mutation in collagen and other portions of connective tissue that make up body parts such as blood vessels
921:
207:: one large vessel leaves the heart instead of two separate vessels, one from the right, one from the left.
278:: inflammatory disease results in damage, hardening, and occlusion to blood vessels leading to narrowing
1041:
939:
269:
260:
gene resulting in an abnormality in pulmonary artery structure along with abnormalities in other organs
797:
222:
151:
Other symptoms are caused by lack of oxygenated blood flow. This causes individuals to present with:
63:
868:
863:
780:
428:
Stents allow for normal vessel growth during childhood and adolescent years, and do not damage the
234:
115:
312:: sound waves provide a real-time picture of the heart including the muscles, valves, and vessels.
47:
Stenosis of the right pulmonary artery in a patient which was due to a case of congenital rubella.
957:
883:
873:
321:
275:
219:: a hole between the right and left upper chambers allows blood from the left to enter the right.
85:
384:
The major reasons for simple balloon angioplasty failure are inability to tear the vessel wall,
422:
835:
831:
331:
389:
216:
8:
828:
769:
297:
188:
982:
978:
878:
713:
686:
627:
533:
204:
774:
88:, a problem with blood clotting in childhood or early adulthood, or a genetic change.
1027:
931:
916:
718:
631:
619:
525:
367:
After the procedure is performed, several factors help determine success. These are:
253:
249:
238:
198:
52:
39:
785:
537:
949:
908:
888:
708:
698:
611:
517:
309:
303:
77:
57:
416:
To solve restenosis and external compression, metal stents were introduced. These
615:
552:"Pulmonary Artery Stenosis | Interventional Cardiology Program | UPMC Children's"
393:
263:
210:
107:
103:
1005:
843:
96:
759:
521:
1064:
898:
284:: infection during pregnancy that can lead to heart abnormalities in neonates
173:
703:
722:
623:
529:
377:
cause of the stenosis (surgically-caused stenosis experiences more success)
81:
344:
144:
742:
827:
385:
137:
99:, poor heart function, and worsening vessel disease across the body.
371:
evidence on imaging or tissue sampling of tearing of the vessel wall
434:
325:
165:
158:
Loss of consciousness (brain not receiving enough oxygen and blood)
92:
315:
281:
257:
754:
361:
687:"Pulmonary arteries: Imaging of pulmonary embolism and beyond"
855:
429:
417:
348:
192:
306:: shows shape and size of the heart and surrounding vessels.
659:"Pulmonary Artery Stenosis: Causes, Symptoms and Treatment"
469:
467:
266:: genetic mutation in a pathway regulating gene expression
334:: dye enhanced x-ray of the pulmonary arteries and veins.
106:
and into the lower right chamber. It travels through the
507:
464:
601:
732:
392:(clot in the vessel), complete artery rupture, and
374:
larger ratio of balloon diameter to vessel diameter
653:
651:
649:
647:
645:
643:
641:
1062:
684:
685:Leitman, Ellen M.; McDermott, Shaunagh (2019).
638:
680:
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402:
813:
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571:
62:
38:
712:
702:
492:
481:. University of California San Francisco
568:
164:Blueing of the lips, fingers, or toes (
14:
1063:
441:high as 43%, and increases over time.
354:
1014:Anomalous pulmonary venous connection
801:
691:Cardiovascular Diagnosis and Therapy
1050:Cerebral arteriovenous malformation
347:, cutting balloon angioplasty, and
245:Genetic and infectious conditions:
24:
996:Persistent left superior vena cava
229:Transposition of the great vessels
25:
1082:
556:Children's Hospital of Pittsburgh
343:The three treatments are balloon
991:Congenital stenosis of vena cava
328:through a vessel into the heart.
411:
74:Pulmonary artery stenosis (PAS)
544:
13:
1:
894:Aneurysm of sinus of Valsalva
457:
316:Computed Tomography (CT) Scan
922:Stenosis of pulmonary artery
616:10.1097/crd.0000000000000300
338:
288:
80:. The pulmonary artery is a
33:Stenosis of pulmonary artery
18:Stenosis of pulmonary artery
7:
1071:Congenital vascular defects
475:"Pulmonary Artery Stenosis"
403:Cutting balloon angioplasty
121:
10:
1087:
1042:Arteriovenous malformation
940:Aberrant subclavian artery
444:
213:: narrowed left side valve
1040:
1004:
977:
970:
948:
930:
907:
854:
842:
736:
522:10.1017/S1047951118001087
223:Ventricular septal defect
179:
161:Reduced physical activity
51:
46:
37:
32:
869:Coarctation of the aorta
864:Patent ductus arteriosus
479:ucsfbenioffchildrens.org
421:prevention of long term
235:Patent ductus arteriosus
116:pulmonary valve stenosis
958:Single umbilical artery
884:Right-sided aortic arch
874:Interrupted aortic arch
704:10.21037/cdt.2018.08.05
510:Cardiology in the Young
322:Cardiac Catheterization
114:PAS is not the same as
86:congenital heart defect
270:Ehlers–Danlos syndrome
76:is a narrowing of the
836:Vascular malformation
143:Elevated heart rate (
697:(Suppl 1): S37–S58.
604:Cardiology in Review
390:deep vein thrombosis
362:layers of the artery
276:Takayasu's arteritis
217:Atrial septal defect
355:Balloon angioplasty
332:Pulmonary Angiogram
189:Tetralogy of Fallot
130:Shortness of breath
983:inferior vena cava
879:Double aortic arch
256:: mutation in the
205:Truncus arteriosus
1058:
1057:
1036:
1035:
1028:Scimitar syndrome
966:
965:
932:Subclavian artery
917:Pulmonary atresia
795:
794:
298:Electrocardiogram
254:Alagille syndrome
250:Williams syndrome
239:ductus arteriosus
199:Pulmonary atresia
136:Rapid breathing (
71:
70:
27:Medical condition
16:(Redirected from
1078:
975:
974:
950:Umbilical artery
909:Pulmonary artery
889:Overriding aorta
852:
851:
832:vascular defects
822:
815:
808:
799:
798:
734:
733:
727:
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682:
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663:Cleveland Clinic
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562:
548:
542:
541:
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78:pulmonary artery
67:
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58:Medical genetics
42:
30:
29:
21:
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569:
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550:
549:
545:
506:
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484:
482:
473:
472:
465:
460:
447:
414:
405:
394:pulmonary edema
357:
341:
291:
264:Noonan syndrome
211:Aortic stenosis
182:
124:
108:pulmonary valve
104:tricuspid valve
61:
28:
23:
22:
15:
12:
11:
5:
1084:
1074:
1073:
1056:
1055:
1053:
1052:
1046:
1044:
1038:
1037:
1034:
1033:
1031:
1030:
1025:
1010:
1008:
1006:Pulmonary vein
1002:
1001:
999:
998:
993:
987:
985:
972:
968:
967:
964:
963:
961:
960:
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905:
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849:
848:other arteries
844:Great arteries
840:
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824:
817:
810:
802:
793:
792:
789:
788:
777:
762:
746:
741:
740:
738:
737:Classification
729:
728:
674:
637:
610:(3): 115–119.
567:
543:
491:
462:
461:
459:
456:
446:
443:
413:
410:
404:
401:
382:
381:
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356:
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329:
324:: inserting a
319:
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310:Echocardiogram
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196:
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97:blood pressure
69:
68:
55:
49:
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43:
35:
34:
26:
9:
6:
4:
3:
2:
1083:
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937:
935:
933:
929:
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920:
918:
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912:
910:
906:
900:
899:Vascular ring
897:
895:
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880:
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724:
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710:
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692:
688:
681:
679:
664:
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650:
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633:
629:
625:
621:
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480:
476:
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423:heart disease
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177:
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174:heart failure
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135:
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41:
36:
31:
19:
779:
764:
749:
694:
690:
666:. Retrieved
662:
607:
603:
559:. Retrieved
555:
546:
516:(2): 93–99.
513:
509:
483:. Retrieved
478:
452:
448:
439:
427:
415:
412:Metal stents
406:
398:
383:
366:
358:
342:
292:
244:
183:
171:
150:
125:
113:
101:
90:
82:blood vessel
73:
72:
971:Great veins
345:angioplasty
304:Chest X-ray
145:tachycardia
829:Congenital
786:D000071079
668:2023-11-02
561:2023-11-02
485:2023-11-02
458:References
386:restenosis
632:211113778
339:Treatment
289:Diagnosis
155:Dizziness
138:tachypnea
53:Specialty
1065:Category
979:Superior
723:31559153
624:32053544
538:58650748
530:30587259
349:stenting
326:catheter
166:cyanosis
122:Symptoms
93:neonates
1022:Partial
714:6732114
445:History
282:Rubella
258:elastin
133:Fatigue
721:
711:
630:
622:
536:
528:
418:stents
180:Causes
60:
1018:Total
856:Aorta
775:747.3
760:Q25.6
628:S2CID
534:S2CID
430:heart
193:aorta
781:MeSH
770:9-CM
719:PMID
620:PMID
526:PMID
435:clot
252:and
766:ICD
751:ICD
709:PMC
699:doi
612:doi
518:doi
1067::
1020:,
834:/
784::
773::
758::
755:10
717:.
707:.
693:.
689:.
677:^
661:.
640:^
626:.
618:.
608:29
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570:^
554:.
532:.
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514:29
512:.
494:^
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396:.
351:.
237::
176:.
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1016:(
981:/
846:/
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814:t
807:v
768:-
753:-
743:D
725:.
701::
695:9
671:.
634:.
614::
564:.
540:.
520::
488:.
195:.
168:)
147:)
140:)
20:)
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
