Primary coronary stent implantation is a feasible bridging therapy to surgery in very low birth weight infants with critical aortic coarctation

Stegeman, Raymond; Breur, Johannes M.P.J.; Heuser, Jörg; Jansen, Nicolaas J. G.; Vries, Willem B. de; Vijlbrief, Daniël C; Molenschot, Mirella; Haas, Felix; Krings, Gregor

doi:10.1016/j.ijcard.2018.03.009

Cited by 24 publications

(25 citation statements)

References 16 publications

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“…All were delivered by cesarean section, of which 3 were emergency deliveries because of an abnormal heart rate pattern in the smaller twin. The median GA at birth was 32 weeks (28)(29)(30)(31)(32)(33)(34). Birth weight of the affected twins ranged from 670 to 1,800 g. The placentas showed gross unequal sharing with little individual territory for the smaller twin, except for the placenta of the case with early twin anemia polycythemia sequence.…”

Section: Resultsmentioning

confidence: 99%

Critical Coarctation of the Aorta in Selective Fetal Growth Restriction and the Role of Coronary Stent Implantation

et al. 2020

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Introduction: Monochorionic twins are at increased risk of congenital heart defects (CHDs). Up to 26% have a birth weight <1,500 g, a CHD requiring neonatal surgery, therefore, poses particular challenges. Objective: The aim of the study was to describe pregnancy characteristics, perinatal management, and outcome of monochorionic twins diagnosed with critical coarctation of the aorta (CoA). Methods: We included monochorionic twins diagnosed with critical CoA (2010–2019) at 2 tertiary referral centers, and we systematically reviewed the literature regarding CoA in monochorionic twins. Results: Seven neonates were included. All were the smaller twin of pregnancies complicated by selective fetal growth restriction. The median gestational age at birth was 32 weeks (28–34). Birth weight of affected twins ranged as 670–1,800 g. One neonate underwent coarctectomy at the age of 1 month (2,330 g). Six underwent stent implantation, performed between day 8 and 40, followed by definitive coarctectomy between 4 and 9 months in 4. All 7 developed normally, except for 1 child with neurodevelopmental delay. Three co-twins had pulmonary stenosis, of whom 1 required balloon valvuloplasty. The literature review revealed 10 cases of CoA, all in the smaller twin. Six cases detected in the first weeks after birth were treated with prostaglandins alone, by repeated transcatheter angioplasty or by surgical repair, with good outcome in 2 out of 6. Conclusions: CoA specifically affects the smaller twin of growth discordant monochorionic twin pairs. Stent implantation is a feasible bridging therapy to surgery in these low birth weight neonates.

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Section: Resultsmentioning

confidence: 99%

Critical Coarctation of the Aorta in Selective Fetal Growth Restriction and the Role of Coronary Stent Implantation

et al. 2020

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“…Patient size may also be an indication; in these cases stent placement facilitates growth of the patient until a coarctectomy can be carried out safely. This has been done in children with a weight as low as 680 g [5]. Again, a short stent is preferable to make the operation as simple as possible; during coarctectomy the stented segment can simply be excised and end-to-end anastomosis performed.…”

Section: Discussionmentioning

confidence: 99%

“…Again, a short stent is preferable to make the operation as simple as possible; during coarctectomy the stented segment can simply be excised and end-to-end anastomosis performed. Operations can be delayed up to 2.5 years, and weight gain can be normalised until then [5].…”

Section: Discussionmentioning

confidence: 99%

“…Stenting of coarctation of the aorta (CoA) is well established in adults and children weighing more than 25 kg, but even in smaller children this technique is gaining acceptance [1,2]. In smaller children aged 3 months or more, ballooning is a treatment option for native and recurrent CoA [3], but there are recent reports of even smaller patients undergoing stent therapy as either a bridge to operation or as primary treatment [4][5][6][7][8][9]. Stenting of coarctations in small children has been carried out for several reasons in a limited number of patients [4][5][6][7][8]10].…”

Section: Introductionmentioning

confidence: 99%

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Indications for stenting of coarctation of the aorta in children under 3 months of age

et al. 2020

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Introduction Coarctation of the aorta in children under 3 months of age is usually treated surgically. However, there are clinical scenarios in which stenting of native or recurrent coarctation may become necessary in this age group. Case reports Four cases illustrate possible indications: left ventricular dysfunction increasing the operative risk, thrombus formation after coarctation surgery, patient size (i.e. in premature babies), and retrograde arch obstruction after hybrid palliation of hypoplastic left heart syndrome. In all babies, coarctation stenting was carried out successfully without complications. Conclusion Coarctation stenting can be carried out safely in small children. Usually, the stent has to be removed or redilated later. Results are encouraging.

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“…4 In addition, our marker strategy also enabled us to dispense with the use of arterial sheaths and aortic catheters that would otherwise be used for control angiographies during stent placement, 10 thus avoiding the vascular complications that are so common in early childhood. 20,21 Neonates and infants of low body weight are at particular risk for periprocedural complications during cardiac catheterization. 22 Any measure to shorten or simplify interventions in this highly vulnerable patient population should be taken.…”

Section: Discussionmentioning

confidence: 99%

Surgically placed radiopaque markers: Proof‐of‐concept of a novel technique to facilitate percutaneous interventions in neonates and infants

Hummel

Kubicki

Pingpoh

et al. 2020

Cathet Cardio Intervent

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Objectives Aim of this study was to evaluate feasibility and benefit of self‐designed, radiopaque markers as a novel technique in neonates and infants with shunt‐ or duct‐dependent lesions. Background Surgically placed radiopaque markers have the potential to facilitate postoperative percutaneous interventions. Methods All consecutive children with surgically placed radiopaque markers involving systemic‐to‐pulmonary artery connections or arterial ducts in the context of hybrid palliation and subsequent cardiac catheterization between January 2013 and March 2019 were included in this analysis. Our primary endpoint was our concept's feasibility, which we defined as a combination of surgical feasibility and the percutaneous intervention's success. Secondary endpoint was the rate of complications resulting from the surgical procedure or during catheterization. Results Radiopaque markers that reveal the proximal entry of a surgical shunt or the arterial duct proved to be a feasible and beneficial approach in 25 postoperative catheterizations. The markers' high accuracy enabled easy probing and proper stent positioning in 13 neonates with a median age and weight of 121 days (range 9–356) and 4.7 kg (1.6–9.4) at the intervention. No procedural complications or unanticipated events associated with the radiopaque marker occurred. The markers were never lost, never migrated, and caused no local obstructive lesion. Surgical removal was straightforward in all patients. Conclusions Radiopaque markers are a promising and refined technique to substantially facilitate target vessel access and enabling the accurate positioning of stents during postoperative percutaneous procedures.

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Primary coronary stent implantation is a feasible bridging therapy to surgery in very low birth weight infants with critical aortic coarctation

Abstract: Primary coronary stent implantation in VLBW infants with critical CoA is a feasible bridging therapy to surgery.

Cited by 24 publications

References 16 publications

Critical Coarctation of the Aorta in Selective Fetal Growth Restriction and the Role of Coronary Stent Implantation

Critical Coarctation of the Aorta in Selective Fetal Growth Restriction and the Role of Coronary Stent Implantation

Indications for stenting of coarctation of the aorta in children under 3 months of age

Surgically placed radiopaque markers: Proof‐of‐concept of a novel technique to facilitate percutaneous interventions in neonates and infants

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