Thomas Zellers - Academia.edu (original) (raw)

Papers by Thomas Zellers

Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 1991

Because we have observed a relatively large number of tricuspid atresia patients with a short P-R... more Because we have observed a relatively large number of tricuspid atresia patients with a short P-R interval and slurring of the initial QRS pattern suggesting preexcitation, we conducted a retrospective study to determine the frequency of this electrocardiographic pattern and whether or not this represented the presence of a true atrioventricular bypass tract. Three pediatric cardiologists reviewed the surface electrocardiograms of 183 consecutive tricuspid atresia patients who had been evaluated at the Mayo Clinic between 1980 and 1986. The patients' ages ranged from 4 months to 21 years; the male-to-female ratio was 5:4. The criteria for preexcitation included 1) a P-R segment <0.10 sec, 2) a QRS complex >0.10 sec, and 3) slurring of the upstroke of the QRS complex ("delta wave"). Of the 183 patients, 22 (12%) had P-R segments <0.10 sec, 9 of whom fulfilled the criteria for preexcitation. Five of these had a history of supraventricular tachycardia, and 4 of t...

The Journal of thoracic and cardiovascular surgery, 1989

After the Fontan operation, patients who had a prior Glenn anastomosis should have less pleural d... more After the Fontan operation, patients who had a prior Glenn anastomosis should have less pleural drainage than patients without a prior Glenn anastomosis because innominate and pleural vein and thoracic duct pressures are unaltered in the former group. To test this hypothesis, we studied 92 patients who had had a Fontan operation between 1973 and 1986--46 with a prior Glenn anastomosis and 46 without a prior Glenn anastomosis (controls)--who were matched for age, gender, diagnosis, and number of prior shunt operations. The volume of pleural drainage was significantly less (p less than 0.05) in the patients with a prior Glenn anastomosis (median 1,959 ml or 48.2 ml/kg) than in the control patients (median, 3,220 ml or 83.4 ml/kg). Similar results were obtained among the patients matched for prior right thoracotomy (n = 28; 1,270 ml and 2,942 ml; p = 0.028). There was no significant difference between the two groups with respect to ventricular end-diastolic pressure, mean right atrial ...

The American journal of physiology, 1992

Alterations in endothelium-derived relaxing factor (EDRF) production or mechanism of action may b... more Alterations in endothelium-derived relaxing factor (EDRF) production or mechanism of action may be involved in the responses of the developing pulmonary vasculature to changes in oxygenation. In this study the effects of acute changes in in vitro oxygen tension on EDRF production were determined in isolated segments of ovine fetal intrapulmonary arteries (4th generation) obtained at 125-135 days of gestation (term 144 +/- 4 days). EDRF production was assessed by measuring segment guanosine 3',5'-cyclic monophosphate (cGMP) accumulation in the presence of a phosphodiesterase inhibitor. Basal (nonstimulated) cGMP production and cGMP production with acetylcholine (ACh) stimulation were dependent on the presence of the endothelium, on the availability of L-arginine, and on soluble guanylate cyclase activity, confirming that they were indicative of EDRF production. cGMP production with sodium nitroprusside (SNP) was used to discriminate changes in the sensitivity of soluble guany...

The Annals of thoracic surgery, 2014

Historic outcomes of patients with heterotaxy and pulmonary atresia or pulmonary stenosis (PA/PS)... more Historic outcomes of patients with heterotaxy and pulmonary atresia or pulmonary stenosis (PA/PS) have been poor and in the current era are incompletely described. We reviewed our management of these patients and associated risk factors for death. We retrospectively reviewed the records of all patients with heterotaxy and PA/PS treated in our institution from January 1, 2002, to August 31, 2012. Death data were also confirmed with the Social Security Death Index. The log-rank test was done to assess six risk factors for death. We identified 42 patients with heterotaxy and PA/PS. Median age at the first operation was 6.5 days, and median follow-up was 3.5 years. Death data were complete for all patients. Overall mortality was 19% (8 of 42). The 30-day, 1-year, and 5-year mortality estimation was 4.76%, 12.3%, and 19.1% respectively, as determined by the Kaplan-Meier method. The log-rank test showed total anomalous pulmonary venous return (TAPVR) (p<0.05) and obstructed TAPVR requi...

JACC: Cardiovascular Interventions, 2014

This study sought to confirm that the short-term hemodynamic effectiveness of the Melody transcat... more This study sought to confirm that the short-term hemodynamic effectiveness of the Melody transcatheter pulmonary valve (TPV) (Medtronic, Inc., Minneapolis, Minnesota) achieved by real-world providers is equivalent to the historical results established in the initial 5-center Investigational Device Exemption trial. TPV replacement has been used to treat right ventricular outflow tract (RVOT) conduit dysfunction for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10 years. The Melody TPV received U.S. Food and Drug Administration approval in 2010 as a Humanitarian Use Device. Patients with dysfunctional RVOT conduits were entered in this prospective, nonrandomized study at 10 centers. The primary endpoint was acceptable hemodynamic function at 6 months post-implantation, defined as a composite of RVOT echocardiographic mean gradient ≤30 mm Hg, pulmonary regurgitation less than moderate as measured by echocardiography, and freedom from conduit reintervention and reoperation. Cardiac catheterization was performed in 120 patients for potential implantation of the Melody TPV; of these, 100 patients were implanted, with a 98.0% procedural success rate. There were no procedure-related deaths. Acceptable hemodynamic function at 6 months was achieved in 96.7% of patients with evaluable data (87.9% of the entire implanted cohort), with results maintained through 1 year. No patient had moderate or severe pulmonary regurgitation after implantation. No patient required catheter reintervention in the first year after implantation, and 2 patients required reoperation for conduit replacement. The rate of freedom from TPV dysfunction was 96.9% at 1 year. This first prospective, real-world experience with the Melody TPV in the United States demonstrates continued high procedural success, excellent short-term TPV function, and low reintervention and reoperation rates at 1 year. (Melody Transcatheter Pulmonary Valve Post-Approval Study; NCT01186692).

Pediatric Research, 1987

ABSTRACT The diagnosis of a left superior vena cava (LSVC) is important in planning the repair of... more ABSTRACT The diagnosis of a left superior vena cava (LSVC) is important in planning the repair of a congenital heart defect as it may be the source of a sizeable right-to-left shunt. The medical record of 65 consecutive pts with a LSVC evaluated at the Mayo Clinic between 1980-1986 were reviewed. All pts had cardiac catheterization (CATH) and two-dimensional echocardiography (2D-ECHO) performed. The M:F ratio was 5:4; the mean age was 8.3 years. Bilateral SVC were present in 59 (91%) and a unilateral SVC was present in 6 (9%), 3 with absent RSVC syndrome. Eighty-one percent of the LSVC entered the coronary sinus CS (11% entered an unroofed CS), 8% entered a pulmonary venous atrium, and 11% entered a common atrium. CATH was used successfully to identify a LSVC in 100% of pts. 2D-ECHO, utilizing contrast and color flow in some pts, was used successfully in 86% (grpl; p=0.008), and unsuccessfully in 14% (grp2). There was no significant difference between the two groups with regard to age, gender, diagnosis, type of SVC or place of drainage. In grpl, a dilated CS was identified in 61%, contrast was used to identify a LSVC in 23%, and 25% were identified as a venous structure entering an atrium. When present the CS was of normal size in grp2 pts. Of the 9 pts, 7 had contrast used and 3 had color flow performed. We conclude: 1) Using 2D-ECHO, a LSVC was successfully identified in only 86% of our pts. 2) The failure to identify 14% could not be attributed to patient age, gender, type of congenital heart disease, type of LSVC or place of drainage. 3) If a suspected LSVC is not identified by 2D-ECHO, other non-invasive means, such as MRI, should be employed.

Pediatric Research, 1996

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Pediatric Researc... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Pediatric Research. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining ...

Pediatric Cardiology, 1996

Protein-losing enteropathy occurs in up to 10% of patients following the modified Fontan procedur... more Protein-losing enteropathy occurs in up to 10% of patients following the modified Fontan procedure. Treatment is still controversial. We describe a female adolescent who developed protein-losing enteropathy 4 years after a modified Fontan procedure. Treatment with oral prednisone attenuated the protein loss with subsequent normalization of her serum total protein and albumin levels. Discontinuation of prednisone therapy was associated with relapse, which was again treated successfully with low-dose oral prednisone. Small bowel biopsy-proved diagnosis with improvement, relapse, and improvement again are documented, as are other useful laboratory findings.

Pediatric Cardiology, 2008

Aspirin is used to prevent thromboembolism in children with heart disease without evidence suppor... more Aspirin is used to prevent thromboembolism in children with heart disease without evidence supporting its efficacy. Studies in adults report a 5%-51% prevalence of aspirin resistance, yet the mechanisms involved are poorly understood. Our aims were to determine its prevalence in these children and to explore its possible mechanisms. One hundred twenty-three cardiac patients routinely receiving aspirin were prospectively enrolled. Platelet function was measured by Platelet Function Analyzer (PFA)-100 using epinephrine and adenosine diphosphate (ADP) agonists. Aspirin resistance was defined as failure to prolong the epinephrine closure time following aspirin administration. Urine levels of 11-dehydro-thromboxane B 2 (11-dTXB 2 ) were measured to determine inhibition of the cyclo-oxygenase pathway. The prevalence of aspirin resistance was 26%. Median ADP closure time was shorter for aspirinresistant (79.60-115 s) than for aspirin-sensitive (100.60-240 s) patients (p \ 0.01). 11-dTXB 2 levels did not correlate with aspirin resistance. Aspirin-resistant patients had higher 11-dTXB 2 levels before (7297 vs. 4160 pg/mg creatinine; p \ 0.01) and after (2153 vs. 1412 pg/mg; p = 0.03) aspirin, with a similar percentage decrease in thromboxane (70.5% vs. 66.1%; p = 0.43). Our findings suggest that resistance is not entirely due to lack of inhibition of platelet thromboxane production. Alternative sources of thromboxane and thromboxane-independent mechanisms, such as ADP-induced platelet activation, may contribute to aspirin resistance.

New England Journal of Medicine, 1997

Persistent pulmonary hypertension of the newborn causes systemic arterial hypoxemia because of in... more Persistent pulmonary hypertension of the newborn causes systemic arterial hypoxemia because of increased pulmonary vascular resistance and right-to-left shunting of deoxygenated blood. Inhaled nitric oxide decreases pulmonary vascular resistance in newborns. We studied whether inhaled nitric oxide decreases severe hypoxemia in infants with persistent pulmonary hypertension. In a prospective, multicenter study, 58 full-term infants with severe hypoxemia and persistent pulmonary hypertension were randomly assigned to breathe either a control gas (nitrogen) or nitric oxide (80 parts per million), mixed with oxygen from a ventilator. If oxygenation increased after 20 minutes and systemic blood pressure did not decrease, the treatment was considered successful and was continued at lower concentrations. Otherwise, it was discontinued and alternative therapies, including extracorporeal membrane oxygenation, were used. Inhaled nitric oxide successfully doubled systemic oxygenation in 16 of 30 infants (53 percent), whereas conventional therapy without inhaled nitric oxide increased oxygenation in only 2 of 28 infants (7 percent). Long-term therapy with inhaled nitric oxide sustained systemic oxygenation in 75 percent of the infants who had initial improvement. Extracorporeal membrane oxygenation was required in 71 percent of the control group and 40 percent of the nitric oxide group (P=0.02). The number of deaths was similar in the two groups. Inhaled nitric oxide did not cause systemic hypotension or increase methemoglobin levels. Inhaled nitric oxide improves systemic oxygenation in infants with persistent pulmonary hypertension and may reduce the need for more invasive treatments.

The Journal of Thoracic and Cardiovascular Surgery, 2010

... V. Vivian Dimas, MD a , * , Steven R. Leonard, MD b , Kristine J. Guleserian, MD b , Joseph M... more ... V. Vivian Dimas, MD a , * , Steven R. Leonard, MD b , Kristine J. Guleserian, MD b , Joseph M. Forbess, MD b , Thomas M. Zellers, MD a ... Ann Thorac Surg 2006;82:158-163.[Abstract/Free Full Text]; Puchalski MD, Williams RV, Hawkins JA, Minich LL, Tani LY. ...

Journal of the American Society of Echocardiography, 2002

Anatomic type and angiographic measurements of patent ductus arteriosus (PDA) are used to determi... more Anatomic type and angiographic measurements of patent ductus arteriosus (PDA) are used to determine the suitability of transcatheter closure (TCC). The purpose of this study is to evaluate whether these PDA features can be obtained by 2-dimensional echocardiography (2DE). We retrospectively compared PDA measurements and type from 36 patients submitted to TCC between November 1995 and October 2000. The patient age ranged between 2 months to 10.5 years (median = 1.2 years). A significant correlation was found between measurements of PDA minimal diameter (R(2) = 0.88) and diameter at aortic ostium (R(2) = 0.72); whereas a poor correlation existed between measurements of the ampulla length. The 2DE and angiographic PDA classification were concordant in 31 of 36 (86%) patients. Our data support the use of 2DE measurements of PDA minimal diameter and PDA diameter at the aortic end to assess suitability for TCC. In the majority of cases, PDA type can be diagnosed by 2DE.

Journal of the American College of Cardiology, 1986

To determine the impact of the Fontan operation on exercise tolerance and on the cardiorespirator... more To determine the impact of the Fontan operation on exercise tolerance and on the cardiorespiratory response to exercise, we compared the results of graded exercise to maximal effort of 81 patients with tricuspid atresia or single functional ventricle studied preoperatively with those of 29 patients studied postoperatively. Postoperatively, the values for total work performed, duration of exercise and maximal oxygen uptake increased significantly. Regardless of operative status, the maximal heart rate during exercise was reduced. The cardiac output and stroke volume response to exercise were subnormal after operation. Systemic arterial blood oxygen saturation was reduced markedly preoperatively both at rest and during exercise; postoperatively, it was significantly greater than the preoperative value but it remained slightly abnormal. The ventilatory response to exercise (respiratory rate, minute ventilation and ventilatory equivalent for oxygen) decreased toward normal after operation. Exercise tolerance and the cardiorespiratory responses to exercise improve after the Fontan operation. Formal exercise testing is essential to quantitate the degree of improvement.

Journal of the American College of Cardiology, 1998

JACC |:ehnlaD r 199~ ABSIRA('r~ (.Ir~d 57A leaflets (46 vs, 20%, p = 0.C0"~) and moderate or seve... more JACC |:ehnlaD r 199~ ABSIRA('r~ (.Ir~d 57A leaflets (46 vs, 20%, p = 0.C0"~) and moderate or severe mdral regurgitation (52 vs, 32%, p = 0,001 ) with :~ut significant age or sex differences, Conclusions' TVP in ass¢ clarion with MVP is infrequent, even in a referral population, and presents in patients with more severe myxomatous valve disease~ 11:45 ~-3~ Enhen~KI Vls,,,sllutlon of Intrnvsscular Thrombus ~

Journal of the American College of Cardiology, 2011

The purpose of this study was to compare the safety and efficacy of surgical, stent, and balloon ... more The purpose of this study was to compare the safety and efficacy of surgical, stent, and balloon angioplasty (BA) treatment of native coarctation acutely and at follow-up. Controversy surrounds the optimal treatment for native coarctation of the aorta. This is the first multicenter study evaluating acute and follow-up outcomes of these 3 treatment options in children weighing &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10 kg. This is a multicenter observational study. Baseline, acute, short-term (3 to 18 months), and intermediate (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;18 months) follow-up hemodynamic, imaging data, and complications were recorded. Between June 2002 and July 2009, 350 patients from 36 institutions were enrolled: 217 underwent stent, 61 underwent BA, and 72 underwent surgery. All 3 arms showed significant improvement acutely and at follow-up in resting systolic blood pressure and upper to lower extremity systolic blood pressure gradient (ULG). Stent was superior to BA in achieving lower ULG acutely. Surgery and stent were superior to BA at short-term follow-up in achieving lower ULG. Stent patients had shorter hospitalization than surgical patients (2.4 vs. 6.4 days; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and fewer complications than surgical and BA patients (2.3%, 8.1%, and 9.8%; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The BA patients were more likely to encounter aortic wall injury, both acutely and at follow-up (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Stent patients had significantly lower acute complications compared with surgery patients or BA patients, although they were more likely to require a planned reintervention. At short-term and intermediate follow-up, stent and surgical patients achieved superior hemodynamic and integrated aortic arch imaging outcomes compared with BA patients. Because of the nonrandomized nature of this study, these results should be interpreted with caution.

The Journal of Pediatrics, 1989

Catheterization and Cardiovascular Interventions, 2000

We report our experience with transcatheter occlusion of the small PDA using Gianturco coils comp... more We report our experience with transcatheter occlusion of the small PDA using Gianturco coils comparing a single coil strategy to a "multiple coil-no residual shunt strategy". Fifteen patients (Group I) had a single coil only placed irrespective of residual shunting and 20 (Group II) were treated using the no residual shunt strategy. Age, minimal PDA diameter, PDA length and PDA types were similar between groups. Closure rates in Group I patients were 60%, 80% and 87% at <1 month, 6 months and 1 year, respectively. In Group II, the <1 month and 6 month closure rates were 100%. The costs and hospital charges for coil closure were comparable to a concurrent surgical group; the total charges (hospital plus physician) were less for Group I, but similar between Group II and the surgical group. The complication rate for coil closure was significantly less than surgical closure. From these data, transcatheter closure with multiple coils can achieve the same closure rate as surgery at similar hospital charges with fewer complications.

Catheterization and Cardiovascular Interventions, 2010

Introduction: Since the 1980s, stent implantation has evolved as an important therapeutic strateg... more Introduction: Since the 1980s, stent implantation has evolved as an important therapeutic strategy for coarctation of the aorta. However, available data is frequently flawed by short follow-up, lack of adequate follow-up imaging, and retrospective nature of data collection. Methods: Data was prospectively collected using a multicenter registry congenital cardiovascular interventional study consortium (CCISC). Between 2000 and 2009, 302 patients from 34 centers with a median weight of 58 kg underwent stent implantation for coarctation. Eligible patients (44%) completed intermediate follow-up (3-18 months) with integrated imaging (cath, CT, MRI), whereas 21% completed long-term follow-up (>18-60 months). Procedural success was defined as UL/LL systolic gradient of less than 20 mm Hg, lack of significant recurrent obstruction, and freedom from unplanned repeat intervention. Results: Acute procedural success was 96%. Cumulative intermediate success was 86%, and cumulative long-term success was 77%. Unplanned repeat interventions were required in 4%, and aortic wall complications were seen in 1% of patients (dissection n 5 1 and aneurysm n 5 3). Other adverse events (n 5 15) occurred mainly acutely and included technical complications such as stent malposition (n 5 9). At long-term follow-up, 23% of patients continued to have systolic blood pressure above the 95th centile, 9% had an upper-to-lower limb blood pressure gradient in excess of 20 mm Hg, and 32% were taking antihypertensive medication. Conclusions: This study documented acute, intermediate, and long-term outcome data comparable or superior with other surgical or interventional series. However, even with successful initial stent therapy, patients continue to require long-term follow-up and have associated long-term morbidity, relating to aortic wall complications, systemic hypertension, recurrent obstruction as well as need for repeat intervention. V C 2010 Wiley-Liss, Inc.

Catheterization and Cardiovascular Interventions, 2009

Background: Balloon angioplasty of bifurcating pulmonary artery (PA) stenoses is often inadequate... more Background: Balloon angioplasty of bifurcating pulmonary artery (PA) stenoses is often inadequate, and stent treatment often requires simultaneous implantation of two stents. This study evaluates initial results and long-term follow up of transcatheter stent placement in bifurcating PAs. Methods: This is a retrospective review of patients (pts) who had bifurcating PA stents placed in main and lobar branches from 1993 to 2007. Results: Forty-nine pts had bifurcating PA stents placed at a median age of 10.9 years (range 1-43 years). The mean minimum vessel diameter increased from 5.7 6 2.5 mm to 11.0 6 3.6 mm (P < 0.001), the mean gradient across the stenoses decreased from 37.0 6 26.9 to 9.2 6 13 mm Hg (P < 0.001), whereas the mean RV:FA ratio decreased from 0.76 6 0.29 to 0.53 6 0.24 (P < 0.001). There was one death due to severe pulmonary hemorrhage. F/U data were available in 38 pts (mean duration 6.3 6 4.1 years, range 1.2-13.1 years). Thirty pts underwent repeat catheterizations (mean 2.3 6 2.2 years poststent), with 26 requiring further interventions: Fifteen had balloon angioplasty alone and 11 had additional stents placed. There were no complications at f/u catheterization. Six pts underwent further palliative surgeries, although none for repair of branch PA stenoses. Conclusions: Simultaneous transcatheter placement of bifurcating PA stents provides immediate gradient relief of bifurcating stenoses in the proximal or lobar branch PAs and reduces RV systolic pressure. Further interventions can be safely performed in future procedures, and the presence of stents does not complicate future surgeries. '