1. Stenting of Single Remaining Pulmonary Artery
Velchev v. , Stoyanov N., nedevska m. ivanchev k.

2. Just another ph patient?
Medical History
Just another ph patient?
56-years-old male referred for PH workup
Fatigue and exertion dyspnea III FC (WHO) started two months ago
Echocardiography – estimated systolic pressure of 100 mmHg, TAPSE 13 mm, Tricuspid regurgitation III-IV
Left Pneumonectomy - two years ago( Lung cancer) f/o radiation and chemotherapy; FU CT 3 mo ago red as “unremarkable” comparing to postop

3. CT angiography
RUPV

4. First Stage - stenting of the pulmonary artery
Treatment plan
multidisciplinary team (oncologist, invasive cardiologist and radiologist) decision making
First Stage - stenting of the pulmonary artery
Second Stage- chemotherapy

5. Literature – not really helpful
Treatment plan
How to do it?
Literature – not really helpful
Call an experienced friend (prof. K.Ivanchev) –
Good support – amplatz wire
Use the selfexpandable stent of suficient size that you know best to stent to the lower lobe branch
Be prepared with balloon expandable stent in case of malexpansion (PS bare)

6. Right catheterization
SPAP 10 mmHg
SPAP 91 mmHg
Gradient through the stenosis-81 mmHg

7. Procedure Planning Right femoral vein - Cook 12 F introducer
It’s simple isn’t it?
Right femoral vein - Cook 12 F introducer
Stenosis crossing with pig tail catheter
Amplatz super stiff guidewire
Wallstent 20/40 mm
Postdilatation

8. Wallstent 20/40 mm

9. Wallstent 20/40 mm

10. Postdilatation 20/16

11. During postdilatation !!!
Blood pressure
Unconsciousness
Inotrope support - Adrenalin, Dopamine

12. Final result

13. Fluorography of stent expansion ten days after the procedure.
SPAP – 60mmHg
II FC (WHO)
Marked reduction of dyspnea
Late stent dilatation up to 10 mm

14. 6 Months Follow Up
Clinical
Return of symptoms of dyspnea on exertion - WHO Class II -III
Echocardiography: Estimated systolic pulmonary arterial pressure - 65 mmHg
Marked weight loss
The patient just finished his third chemotherapy course.

15. CT-angiograph – encasement of patent RPA, continuing stent expansion
6 Months Follow Up
CT-angiograph – encasement of patent RPA, continuing stent expansion

16. CT- angiography- Disease progression
6 Months Follow Up
CT- angiography- Disease progression
RUPV compression
Ground glass appearance
of dependent lung parenchyma

17. RUPV stenting with transseptal approach

18. Risk/benefit ratio is difficult to calculate in desperate situation
What do we learn?
Treating malignant compression you need to be prepared for issue of stent malexpansion
Risk/benefit ratio is difficult to calculate in desperate situation
Treating big vessel malignant compression can gain quality and quantity of life and