# Percutaneous treatment of severe branch pulmonary stenosis in children who underwent branch pulmonary artery stenting in infancy: how to deal with stents that cannot be expanded to adult size—case reports

## TL;DR

This paper presents a treatment strategy for children with branch pulmonary stenosis who had stents in infancy that can no longer expand, using adult-sized stents to relieve the blockage.

## Contribution

The paper introduces a successful lifelong strategy using adult-sized stents for treating severe branch pulmonary stenosis in older children.

## Key findings

- Percutaneous re-stenting with adult-sized stents completely relieved stenosis in two older children.
- A treatment strategy involving high-pressure balloons and planned re-stenting can be successfully implemented.
- Choosing the right timing and types of stents is crucial for successful treatment.

## Abstract

Current paediatric and congenital interventional cardiologists are increasingly dealing with patients who underwent branch pulmonary artery stenting during infancy and present with severe re-stenosis at follow-up due to reaching the limit of stent expansion because stent dimensions no longer match the distal vessel diameter.

We report two cases of older children who underwent branch pulmonary artery stenting in infancy where percutaneous re-stenting with adult-sized stents relieved the stenosis completely and has been employed as a lifelong strategy.

Serial balloon angioplasty with high-pressure balloons, planned re-stenting with adult-sized stents before intentional fracture of the initially implanted stents, and choosing the right timing and types of stents are parts of the treatment strategy that can be implemented successfully in many paediatric patients with branch pulmonary artery stenosis.