Open Access

ARTICLE

Long-Term Follow-Up of Percutaneous Stent Implantation for Residual Pulmonary Artery Stenosis in Pediatric Patients after Surgical Repair of Complicated Congenital Heart Diseases

Yifan Li^1,#, Xu Huang^2,#, Bingyu Ma³, Ling Sun¹, Shushui Wang¹, Zhiwei Zhang¹, Yumei Xie^1,*

1 Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510100, China
2 Department of Cardiology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China
3 Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China

* Corresponding Author: Yumei Xie. Email:
# These authors contributed equally to this work

Congenital Heart Disease 2025, 20(4), 463-475. https://doi.org/10.32604/chd.2025.068286

Received 24 May 2025; Accepted 29 August 2025; Issue published 18 September 2025

Abstract

Objective: The aim of the present study was to investigate long-term efficacy and safety of percutaneous stent implantation for residual pulmonary artery stenosis (PAS) in pediatric patients after surgical repair of complicated congenital heart diseases (CHDs). Methods: All pediatric patients diagnosed with residual PAS after surgical repair of complicated CHDs between 1996 and 2020 were retrospectively enrolled in the study. Results: A total of 41 patients (30 males, 11 females; median age 5.0 years, median weight 17 kg) were followed-up for a median of 7.1 years. Follow-up echocardiography results demonstrated that the target vessel diameter increased from (3.4 ± 1.1) mm preoperatively to (6.2 ± 1.9) mm one year post-procedure and (6.0 ± 1.5) mm at the final follow-up (p < 0.05). The pressure gradient across the stenosis decreased from (52.6 ± 15.8) mmHg preoperatively to (35.8 ± 19.1) mmHg one year post-procedure and (33.1 ± 19.7) mmHg at the final follow-up (p < 0.05). Cardiac computed tomography scans indicated that target vessel/distal vessel diameter ratio increased from (0.4 ± 0.2) pre-operatively to (0.8 ± 0.2) one year post-procedure and (0.9 ± 0.3) at the final follow-up (p < 0.05). A total of six adverse events were documented, comprising two cases of in-stent restenosis requiring surgical reintervention, three cases of in-stent restenosis managed with regular clinical surveillance, and one case of percutaneous pulmonary valve replacement due to severe pulmonary regurgitation. Kaplan-Meier event-free survival analysis demonstrated that elevated preprocedural right ventricular systolic pressure (>72 mmHg) was significantly associated with long-term adverse events (p = 0.024). Conclusion: Percutaneous stent implantation for residual PAS after surgical repair of complicated CHDs effectively relieves vessel stenosis, stabilizes cardiac function, and improves long-term prognosis in pediatric patients. In-stent restenosis remains an unresolved complication, necessitating further advancements in interventional strategies.

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