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PAS Intervention Training Program

Date: 2018-01-09
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Brief Introduction

Pulmonary artery stenosis can occur in the main pulmonary artery, left and right pulmonary artery and pulmonary artery branches.  Stenosis can be single or multiple, limited, segmental or diffused, and also can be unilateral or bilateral.  The reasons can be divided into congenital and secondary.  Most congenital pulmonary stenoses are the result of congenital heart disease with pulmonary circulation malformation, such as Tetralogy of Fallot, pulmonary atresia, and tricuspid atresia with pulmonary stenosis.  Most secondary pulmonary stenoses are due to surgical operations.  After surgery, patients with complex congenital heart diseases will develop anastomotic stenosis or the extracardiac tract stenosis, where the right ventricular outflow tract connected to the pulmonary artery [1].

In China, the incidence of congenital heart disease is very high. According to the China Cardiovascular Disease Report 2016 released in 2017, there are about 2 million people with congenital heart disease [2].  Every year, about 120,000 children are born with congenital heart disease, about 20% of them with congenital complex heart disease [3].  Pulmonary artery branch stenosis is a common postoperative complication of patient with congenital complex heart disease, such as Tetralogy of Fallot, etc [4].  One reason is that the primary lesion of the branch pulmonary artery itself has a stenosis, which is difficult to reach by surgical means. Another reason is the scar formation or blood vessel pulling and twisting at the anastomotic stoma [5]. Postoperative stenosis usually occurred in the left and right pulmonary bifurcation [7].  Due to postoperative tissue scarring and adhesions, it is very difficult for surgeons to reopen the surgical site.  To avoid the second or third time thoracotomy, transcatheter balloon dilatation or stenting is becoming the preferred treatment method [6] [7].  The causes and pathological changes of postoperative pulmonary artery stenosis are different from the ones of congenital pulmonary valvular and/or subvalvular stenosis.  The blood vessel at the stenosed part itself did not heal well.  Besides this, because of surgical scar formation, the balloon dilation affect is not good.  More important, restenosis could occur due to elastic retraction of the vessel wall and compressing of surrounding anatomic structure [7].

A pulmonary artery stent can provide sustained vascular support, proven to be an optimal method with good safety and effectiveness. However, there is no stent indicated for pulmonary artery stenosis in the world.  Most of the stents used to treat pulmonary artery stenosis are indicated for other types of stenting. Although there is a certain clinical efficacy, there are many limitations for these kinds of stents such as poor flexibility, and high axial contraction rate.  To overcome these limitations, Med-Zenith developed a balloon-expandable stent (Pul-Stent) indicated for pulmonary artery stenosis. It is a cobalt-based stent with many advantages demonstrated in experiments, such as good biocompatibility, high X-ray opacity, and good strength. According to the structure of the pulmonary artery, this stent cleverly balances stent flexibility and good strength. The Pul-Stent has variety of specifications, which meets different clinic demands. So far, the interventional procedures for pulmonary artery stent implantation are not widely performed in domestic hospitals. Med-Zenith provides a series of training programs for healthcare professionals with interventional treatment for pulmonary artery stenosis.

Figure 1: Normal Heart left Heart with tetralogy of Fallot right

PAS Intervention Training Program


Figure 2: Left pulmonary artery stenosis before surgery

PAS Intervention Training Program


Figure 3: Left pulmonary artery stenosis after surgery

PAS Intervention Training Program


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References:

【1】Yang Ruijin, et al. Stent treatment and advances for pulmonary stenosis. Chin J Intervent Cardiol. 2009; 17 (5): 295-298.

【2】Chen Weiwei, et al. The summary of China Cardiovascular Disease Report 2016. Chinese Circulation Journal. 2017; 32(6): 521-530.

【3】ZW Zhang, et al. The progress and challenges of surgical treatment for congenital heart disease.  Practical Journal of Clinical Medicine. 2016; 13 (4): 26-31.

【4】Liu T, et al. Initial experience with the new Pul-Stent in treating postoperative branch pulmonary artery stenosis. Zhonghua Er Ke Za Zhi. 2015; 53(3): 208-13.

【5】Bacha EA, et al. Comprehensive management of branch pulmonary artery stenosis. J Interv Cardiol. 2001; 14(3): 367-375.

【6】Xie Yumei, et al.Endovascular stent implantation to rehabilitate residual branch pulmonary artery stenosis in children after surgical repair with complex congenital heart disease. Chinese Journal of Thoracic and Cardiovascular Surgery. 2015; 31 (8): 449-452.

【7】YC Chen, et al. Use of Pulmonary Stent in Congenital Complex Heart Disease. Advances in Cardiovascular Diseases. 2010; 31(05): 645-648.

【8】GAO Wei, et al. Stent Implantation for Residual Branch Pulmonary Artery Stenosis after Therapy Treatment of Congenital Heart D is easy. Chinese Journal of General Practice. 2010; 08(12): 1498-1500.



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