Circulation, Vol 83, 1923-1939, Copyright © 1991 by American Heart Association
MP O'Laughlin, SB Perry, JE Lock and CE Mullins
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.
ARTICLES
Use of endovascular stents in congenital heart disease
Lillie Frank Abercrombie Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
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