Implantation and intermediate-term follow-up of stents in congenital heart disease.

Abstract

BACKGROUND Balloon-expandable stents (Johnson and Johnson Interventional Systems) have been in use for congenital heart disease since late 1989. They have made possible treatment in previously untreatable branch pulmonary artery stenoses and systemic venous stenosis. The purpose of this report is to detail the results and intermediate-term follow-up of stents used for treatment of congenital heart disease. METHODS AND RESULTS Eighty-five patients underwent placement of 121 stents in Houston and Boston. Fifty-eight patients had stents put in pulmonary arteries, nine had stents in conduits or outflow tracts, and 21 had stents in venous stenoses or narrowed Fontan anastomoses. (Three patients had stents in two locations.) These stent procedures resulted in gradient reduction from 55.2 +/- 33.3 to 14.2 +/- 13.5 mm Hg in pulmonary arteries, from 41.4 +/- 26.0 to 20.7 +/- 17.0 mm Hg in conduits or outflow tracts, and from 9.8 +/- 6.9 to 2.4 +/- 3.1 mm Hg in venous stenoses or Fontan anastomoses. Diameter of narrowings increased from 4.6 +/- 2.3 to 11.3 +/- 3.2 mm in the pulmonary artery, from 8.8 +/- 3.6 to 12.7 +/- 2.6 in conduits, and from 3.8 +/- 2.9 to 11.3 +/- 2.8 in venous stenoses. Follow-up has shown stent fracture in one patient, restenosis in one, and sudden death in one. Recatheterization has been done in 38 patients an average of 8.6 months after stent installation. Compared with immediately postimplant data, there was no significant change in luminal diameter or pressure gradient. Redilation was performed in 14 patients (17 stents) 1 week to 24 months after implantation (mean, 10.2 months), with a small but significant increase in stenosis diameter. CONCLUSIONS We conclude that stent treatment of vascular stenoses in congenital heart disease retains efficacy at medium-term follow-up and offers a much-improved outlook for patients with these lesions.

Transcatheter Stent Therapy in Children: An Update

“…They found that the peak pressure gradients decreased (51 +/-24 vs. 16 +/-13 mmHg; p<0.01) and the vessel diameter increased (5 +/-3 vs. 11 +/-4 mm; p<0.01). Subsequent studies [16,17,[48][49][50][52][53][54][55][56][57], including our own [25,50] documented similar results. The results are similar in both post-operative and native BPAS lesions [17].…”

“…Follow-up studies [17,59,60] of the cohort reported by O'Laughlin et al [48] revealed minimal loss of stent diameter, mild increase in gradient with true stenosis in only 7% of stents. However, 30 of the 31 stents required re-dilatation either due to development of severe stenosis (7%), residual waist (33%) or limited dilatation at the time of initial stent implantation (60%).…”

“…There are several publications on the immediate and short term results, but long term follow-up studies are scant [17,48,49,58,59]. Follow-up studies [17,59,60] of the cohort reported by O'Laughlin et al [48] revealed minimal loss of stent diameter, mild increase in gradient with true stenosis in only 7% of stents.…”

“…Even with this technical improvement, success rate remained low, complication (ruptured pulmonary artery, hemoptysis, pulmonary edema, pulmonary artery aneurysm) rate was high, and recurrence rate was significant [43][44][45][46]. Consequently balloon expandable stents, first introduced by Palmaz et al [7], have been adopted for management of BPAS [11,16,17,[48][49][50] …”

Management of the Fontan circulation in the adult patient

“…(53,57) (58,59) These narrowed parts of the Fontan circuit would typically be addressed in the catheter laboratory with balloon dilatation or stent implantation in the older child and adult. (30,(60)(61)(62) …”