Airway Management in Fontan Patients with LPA Stenosis

Left pulmonary artery (LPA) stenosis is encountered in up to 65% of patients with a Fontan circulation. Stenting of LPA stenosis can be complicated by compression of the left bronchus. We evaluated the effect of periprocedural airway management with three-dimensional rotational angiography (3DRA) and bronchoscopy on the occurrence of left main bronchus compression in Fontan patients undergoing percutaneous treatment for LPA stenosis. All pediatric cardiac catheterizations for LPA stenosis between 2011 and 2024 as well as the pre- and postoperative course were analyzed. In 64 of a total of 109 procedures airway imaging was used (3DRA (n = 50), bronchoscopy (n = 1), bronchoscopy and 3DRA (n = 13)). Airway imaging led to an adaptation of the intervention in 43 cases; stent ovalization was performed in 23 cases, balloon interrogation with simultaneous airway visualization was performed in 24 cases and the intended procedure was abandoned in two cases. In six cases balloon dilatation of a compressed left main bronchus was performed with mild success in two cases where balloon dilatation led to altered LPA stent morphology increasing the lumen of the left main bronchus. Thus, the left main bronchus is at high risk for compression when LPA stenting is performed in patients with a Fontan circulation. Periprocedural imaging of the airway has the potential to prevent airway compression. Bronchus dilatation offered no successful treatment for airway compression by an LPA stent.