Use of endovascular stents in congenital heart disease.

Abstract

BACKGROUND Balloon expandable intravascular stents have been used to support vessel walls in coronary and peripheral arteries in adults. The purpose of this study was to examine the efficacy and safety of these stents in the treatment of congenital heart disease. METHODS AND RESULTS Forty-five stents were placed in 30 patients, who were 0.2-30.2 years old (weight, 3.5-76 kg). Patients with areas of stenosis that were difficult to approach surgically were chosen. Stents were mounted over balloons and placed by standard catheterization techniques. Twenty-three patients had branch pulmonary artery stenosis. Thirty-six stents were placed successfully and had reduced pressure gradients from 50.6 +/- 24 to 15.9 +/- 13.4 mm Hg. Five patients had stents placed after atrial surgery: three in obstructed Fontan repairs, one at the superior vena cava-right atrial junction after sinus venous defect repair, and one at the site of a Glenn shunt. Atrial stents reduced pressure gradients from 9.8 +/- 8.2 to 2.0 +/- 2.6 mm Hg. One patient had a stent placed in the descending aorta after coarctation dilation, and the pressure gradient was reduced from 50 to 25 mm Hg. One patient had pulmonary vein dilation with stent placement. Two stents migrated at the time of placement; one required surgical removal, and one was anchored in place by balloon dilation. One patient died within 24 hours of catheterization because of thrombus obstruction of the Fontan repair. Nine patients have undergone recatheterization. All stented vessels have remained at the same caliber as at original stent placement. CONCLUSIONS We conclude that balloon expandable stents are useful in selected postoperative stenoses in congenital heart disease.

Transcatheter Stent Therapy in Children: An Update

“…In the first series of BPAS stents, O'Laughlin et al [11] reported their results with 35 stents in 23 patients. 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).…”

“…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] …”

“…Subsequent clinical studies showed the stents to be successful in subjects with obstructive lesions of coronary, iliac and renal arteries [6][7][8][9]. Mullins, O'Laughlin et al [10,11] introduced endovascular stents into pediatric practice. Stents were used to treat obstructions in pulmonary arteries, systemic and pulmonary veins, aorta and right ventricular outflow tract (RVOT) conduits [12][13][14][15][16][17][18].…”

Transcatheter Angioplasty for Acquired Pulmonary Vein Stenosis After Radiofrequency Ablation

“…[23][24][25][26][27][28][29][30][31][32][33][34] Surgical approach has been tried in some instances, with variable results, depending on the technique used, anatomy, and timing of surgery. 24,26,31,34 In children, balloon angioplasty for PVS has been uniformly unsuccessful.…”

“…32,33 In addition, endovascular stenting of the pulmonary veins in children has met with little clinical success. 25,[27][28][29][30] On the other hand, stent placement in the pulmonary veins after extrinsic compression in adults has yielded some clinical success. 23 The application of energy in the region of the pulmonary veins results in formation of organizing thrombus, necrotic myocardium, endovascular contraction, and proliferation of elastic lamina, in addition to intimal proliferation.…”