Implantation of stents for treatment of recurrent and native coarctation in children weighing less than 20 kilograms

Abstract

We report our experience with implantation of stents for treatment of recurrent and native aortic coarctation in children weighing less than 20 kilograms. We treated 9 such patients between March, 2003, and January, 2006. In 2 patients, the coarctation had not previously been treated, while in 7 it had recurred after surgery. The patients had a median weight of 14 kilograms, with a range from 5.5 to 19 kilograms. Balloon dilation was needed in 1 patient before the stent was implanted. We used Palmaz Genesis XD stents in 7 patients, these having lengths from 19 to 29 millimetres, 1 Palmaz Genesis 124P stent, and 1 peripheral JoStent with a diameter of 6 to 12 millimetres. Implantation was effective in all patients. Immediately after implantation, the mean peak systolic gradient decreased from 30 millimetres of mercury, the range having been 15 to 50 mm, to 3 millimetres of mercury, with the final range from zero to 10 mm. There were no complications, with no observations of aneurysms, dissections, or dislocated stents. In 1 patient, the peripheral pulse was weak secondary to arterial access, but treatment with Heparin led to complete resolution. It was necessary to re-dilate the stent in another patient, while 2 others are scheduled for redilation because of growth-related restenosis. Our findings suggest that implantation of stents can produce excellent relief of the gradient produced by recurrent or native coarctation. The process is safe and effective in patients weighing less than 20 kilograms.

Stent Implantation for Coarctation of the Aorta in Children <30 kg

“…Golden and Hellenbrand (2), in their review of the Congenital Cardiovascular Interventional Study Consortium data consisting of 588 stent placements for CoA in children and adults from 17 centers, report only 7% (40 of 588) of the patients were under 6 years of age. Schaeffler et al (24) reported 9 patients with a median weight of 14 kg (range 5.5 to 19 kg) who underwent successful stent placement for CoA. In our study, we report 22 patients with a median weight of 20.7 kg (range 9.7 to 27 kg).…”

Myotube orientation using strong static magnetic fields

“…This report contains the largest reported series of stent redilation procedures for COA [6, 8–11]. Of the 28 attempts during the study period, 26 attempts (93%) were successful.…”

Transcatheter Stent Therapy in Children: An Update

“…In the older child, adolescent and adult, primary stent therapy is advised both for native aortic coarctation and post-surgical recoarctation. Because of issues related to growth and the need for large sheaths for implantation, most cardiologists limit stent usage to adolescents and adults, although some workers [15,105,[111][112][113][114] advocate stents in infants and young children. We do not advocate routine use of stents in neonates, infants and young children [106,115].…”