The use of small stents to delay surgical intervention in very young children with critical congenital heart disease (original) (raw)
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Intraoperative Stenting of Pulmonary Artery Stenosis in Children With Congenital Heart Disease
The Annals of thoracic surgery, 2017
Branch pulmonary artery (BPA) stenosis is frequently associated with congenital heart disease. Management of BPA stenosis is challenging for surgeons due to a high rate of recurrence. The purpose of this study was to assess the results of intraoperative pulmonary artery stenting associated with or without surgical angioplasty. We included 33 children from our center between January 2008 and July 2014. Patients had pulmonary atresia with ventricular septal defect (13), tetralogy of Fallot (10), troncus arteriosus (4), double outlet right ventricle (2), and single left or right ventricle (4). A total of 44 balloon-expandable stents (mean diameter, 9.5 mm; range, 4 to 16 mm) were deployed in left or right PA under direct visualization, without the use of fluoroscopy, after branch angioplasty for 28 of them (64%). The mean age at surgery was 4.3 ± 4.3 years (range, 6 days to 15 years) and the mean weight was 14.3 ± 11.9 kg (range, 2.8 to 63 kg). Postoperative mortality was 9% (3 patient...
Catheterization and Cardiovascular Interventions, 2008
Background: Stents implantation in infants has been shown to be feasible, however, there are no published reports examining long-term outcomes. Concerns exist regarding creation of fixed obstructions secondary to the stent if expansion to larger diameters over time is not possible. Methods: A retrospective analysis of the earliest consecutive series of infants who underwent stent placement at our institution between October 1995 and December 1999. Results: Implantation of 33 stents were attempted in 27 infants, median age = 10 (25–24) months, wt = 8.1 (3.4–14.5) kg. Stents used were as follows: 16 large, 13 medium, and 4 coronary. Acute implant success was 94%. There were three nonprocedure-related deaths within 30 days of implantation, 1 patient was lost to follow-up and 1 had acute stent thrombosis. The remaining 22 patients (26 stents) form the long-term follow-up study group. Nineteen stents underwent 33 redilations. Following latest redilation, 67.0 (37–113) months postimplantation, minimal luminal diameter increased from 7.0 ± 1.8 mm immediately following implantation to 8.7 ± 2.3 mm (P < 0.001). Seven stents were electively removed/ligated during a planned surgery. All 18 remaining in situ stents are patent without significant obstruction 102 (84–116) months following implantation. There was one late death 51 months after stent implantation. The remaining 21 patients are alive and well. Conclusions: Stent implantation in infants is safe and effective. Serial redilation is possible to keep pace with somatic growth; however, efforts should be made to implant stents with adult diameter potential in children who will not require further cardiac surgery. Implantation of small- and medium-sized stents can provide effective palliation and should be considered in carefully selected infants who will ultimately require future surgery. © 2008 Wiley-Liss, Inc.
The American journal of case reports, 2014
Case series Patient: - Pulmonary artery stenosis Symptoms: - - Clinical Procedure: - Specialty: - Congenital defects/diseases • Unusual or unexpected effect of treatment. The decision of which stent can be used for treating a congenital heart lesion can be difficult for a pediatric interventional cardiologist. Features of an ideal stent would be to have a low profile to enable small sheaths to be fitted and allow for advancement. It would need to be flexible to negotiate curves of arteries and have sufficient radial strength to prevent recoil of the lesion and vessel. It should have high trackability and wide struts to enable junctional artery flow and prevention of thrombosis and toxic adverse effects from the stent. Much work is being carried out to design the ideal stent and provide the best treatment for congenital heart lesions. We investigated this matter with the use of the Valeo stent in 2 patients. The Valeo stent is a new premounted stent with several advantages for use in...
2015
Aims Stenting has become an established interventional cardiology procedure for congenital heart disease. Although most stent procedures are completed successfully, complications may occur. This mul-ticentre study evaluated early complications after stenting in patients with congenital heart disease, including potential risk factors. Methods and results In this combined Dutch–Belgian retrospective study, 309 consecutive patients had undergone 366 catheterizations and received 464 stents in 13 different anatomical positions (418 sites). Seventy-two stenting-related complications (19%) occurred, of which 24 (5.7%) were major. Seven procedure-related deaths were documented (2.3%). Stent malpositioning and embolization were most common (7.7%). The use of non-premounted stents tended to be associated with higher complication rates. Centre inexperience with stenting and stenting of native vs. post-surgical stenosis tended to be associated with increased major complication rates. Conclusio...
Endovascular stents in children under 1 year of age: acute impact and late results
Heart, 1995
Objectives-To review efficacy and safety of endovascular stent implants in children < 1 year of age with congenital heart lesions. Design-Retrospective study of patients in a tertiary care setting. Patients-26 children (median age of 47 months, range 2 days to 1 year) with various vascular obstructive lesions. Intervention-Percutaneous or intraoperative implantation of balloon expandable endovascular stents. Results-Optimal stent placement was obtained in 31 of the 37 deployed implants. Complications resulted primarily from stent malpositioning and one episode of bleeding at a puncture site. Stent implantation in three patients with a restrictive arterial duct allowed for patency and five patients with conduit stenosis had mean (SD) right ventricule to systemic artery pressure ratios falling from 0 99 (0.20) to 0 52 (0.18) (P < 0.05). In 10 patients with pulmonary artery stenosis, the mean vessel diameter increased from 2-8 (0.9) mm to 5 8 (1.4) mm (P << 0.001). No clinical improvement was seen in two patients because of diffuse hypoplasia of the pulmonary vessels. Nine of 10 patients with miscellaneous obstructive lesions improved clinically. Recatheterisation was performed in 19 patients (median 8 months, range 12 days to 28 months) and 11 patients required redilatation (17 stents). Conclusions-Stent implantation is technically feasible in infants and under specific circumstances may provide an alternative to surgical palliation or avoid reoperation. The long term impact on clinical course, however, involves further interventions directed at stent management.