Stent Angioplasty for Post-Operative Coronary Artery Stenosis in Infants

Abstract

Introduction While frequently performed in the adult population, percutaneous coronary artery stent angioplasty (CSA) in infants is rare. CSA in infants is challenging because of limited options in terms of appropriately sized (length and diameter) stents, concern about stenting vessels with significant growth potential and limited data regarding durability of benefit. We report a multicenter case series of infants who underwent CSA. Methods A multicenter, retrospective case series of infants who underwent percutaneous CSA to treat post-operative coronary artery stenoses was performed. Results Six infants from 3 institutions who underwent post-operative CSA were identified. The anatomic diagnoses were d-transposition of the great arteries in 3 cases, anomalous left coronary artery from the pulmonary artery in 2 and supravalvar aortic stenosis in 1. All infants were critically ill at the time of CSA. Diameters of coronary artery stents used ranged from 2.25 to 2.75 mm. There were no procedural complications. All stents were patent immediately after placement and the clinical condition improved or stabilized in all patients. Follow-up angiography was available for 3 patients at 4 to 16 months post-CSA, at which time 67% (2/3) remained patent. Conclusion CSA is a feasible and effective therapy for critically ill infants with post-surgical coronary obstruction. Treatment appears to allow at least short-term reperfusion to facilitate recovery of ventricular function and potential development of collateral circulation when longer-term stent patency is not achieved. Longer-term stent patency and coronary artery health remain unanswered questions.

Percutaneous coronary stent implantation in children and young infants following surgical repair of congenital heart disease

“…It can be used as a bridge to elective CABG or reparative surgery in patients presenting with CAO and depressed myocardial function ( 9 ). CSI may play an essential role in neonates undergoing extensive surgical repairs, particularly in cases where additional coronary manipulation may be challenging ( 10 ).…”

“…Since the first successful coronary stenting in 1998 for a 4-year-old child following CHD surgery ( 17 ), several case reports were published, and a few small case series ( 1 , 4 , 5 , 9 , 10 ). Reviewing the literature, a few reports included infants who underwent CSI after cardiac surgery ( 10 , 18 - 21 ).…”

“…CSI may induce acute coronary injury that activates a cascade stimulating platelet aggregation ( 24 ). DAPT with acetylsalicylic acid (aspirin) and clopidogrel was used in the reported pediatric small case series and proved to be essential to prevent in-stent restenosis ( 5 , 9 , 10 ). Similarly, we have chosen to treat our patients with DAPT, and the patients did not experience problems using this antiplatelet therapy regimen.…”

“…In patients with LV dysfunction, it has been demonstrated that they benefit from PCI and LV function normalized within 3 to 6 weeks ( 14 ), or it may take up to 6 months to recover completely after the intervention ( 9 , 10 , 20 ). Our study showed marked improvement in LV function with EF normalization in 4 out of 6 patients who survived hospital discharge.…”

“…There are only a few reports on managing postoperative CAO with coronary stent implantation (CSI), which were small case series and case reports ( 1 , 4 , 5 , 9 , 10 ). Accordingly, the available data describing patient characteristics, presentation modalities, diagnostic criteria, and outcomes of CSI in children is limited ( 1 ).…”