Surgical removal of pulmonary flow restrictors in children with congenital heart disease: What the outcomes reveal.

Haddad, RN.; Bentham, J.; Pardo, C.; Alloush, R.; Al Soufi, M.; Jaber, O.; Kasem, M.; El Rassi, I.

Surgical removal of pulmonary flow restrictors in children with congenital heart disease: What the outcomes reveal.

All Authors

Haddad, RN.

Bentham, J.

Pardo, C.

Alloush, R.

Al Soufi, M.

Jaber, O.

Kasem, M.

El Rassi, I.

LTHT Author

Bentham, Jamie
Jaber, Osama

LTHT Department

Cardio-Respiratory
Cardiology
Congenital Cardiac Services
Leeds Children's Hospital
Congenital Cardiac Services

Publication Date

2025

Item Type

Journal Article

Abstract

Objective: Pulmonary flow restrictors (PFRs) are interesting devices, but their surgical removal outcomes are poorly understood. Methods: Retrospective review of clinical data from children with bilateral PFRs who underwent device removal during follow-up surgery. Results: Thirty-four PFRs were explanted from 17 patients (41.2% boys) at a median of 2 months (interquartile range [IQR], 1.2-5.2 months) postimplantation, with a median patient age of 2.5 months (IQR, 1.6-5.8 months). One patient experienced life-threatening bilateral pulmonary artery (PA) aneurysms 2 months after PFR implantation, necessitating urgent surgery. Two PFRs were found migrated across the left PA's upper lobe branch origin. Twenty-six were removed intact, 1 in 2 fragments, and 7 piecemeal. No thrombus was noted. Neoendothelium was observed on 11 PFRs. Seven PFRs caused endothelial damage, requiring sharp and blunt dissection for removal. Six right and 4 left PA arteriotomies were patched. Hegar dilators, with median sizes of 7 mm (IQR, 6.8-8.3 mm) for right PA and 7 mm (IQR, 7-8 mm) for left PA, confirmed branch patency. At a median follow-up of 14.8 months (IQR, 10.2-18.3 months), echocardiographic maximum velocities in 13 biventricular patients and 2 awaiting future biventricular repair were 1.5 m/second (IQR, 1.4-1.7 m/second) for the left PA and 1.6 m/second (IQR, 1.4-1.7 m/second) for the right PA. One patient with deferred Norwood had normal PAs and well-positioned PFRs on prestage-II catheterization. A patient who underwent stage-II Norwood 3.2 months post-PFR implantation died from sepsis 1 month later, but post-Glenn angiogram revealed no stenosis. Conclusions: PFR removal is safe and effective. Complications are manageable, with no PA stenosis observed.