Pulmonary artery stenosis following aortopulmonary anastomoses.

From 1965 to 1979, 44 patients with Potts and 50 with Waterston aortopulmonary anastomoses were studied angiographically. Fifty-two of the 95 shunts had been banded to limit growth of the anastomosis. Later the internal diameter of the anastomosis was measured in 34 children when the cardiac defect was repaired. On those with late measurements, growth was limited effectively in 17 of the 18 (94%) shunts that had been banded, whereas five of the 16 (31%) unbanded anastomoses grew to more than 6.5 mm internal diameter (p = 0.05). The difference in incidence of moderate or severe stenosis of the pulmonary artery near or at the anastomosis nearly reached a significant level (p = 0.07), occurring in 50% of children with banded shunts in comparison with 31% of children with unbanded shunts. Mean pulmonary artery pressures were obtained in 77 children, 36 with potts and 41 with Waterston shunts. Six of 43 with a banded anastomosis had a mean pulmonary artery pressure above 30 mm Hg, the highest being 43 mm Hg. Seven of 34 children with an unbanded anastomosis had a mean pulmonary artery pressure of 30 mm Hg or more, and in three the pressures were over 50mm Hg. In unbanded Potts or Waterston shunts the incidence of pulmonary artery stenosis was 60%. This high incidence discourages the use of these aortopulmonary anastomoses if other shunts can be constructed safely and effectively.