Implantation and intermediate-term follow-up of stents in congenital heart disease

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Circulation. 1993;88:605-614

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ARTICLES

Implantation and intermediate-term follow-up of stents in congenital heart disease

MP O'Laughlin, MC Slack, RG Grifka, SB Perry, JE Lock and CE Mullins
Division of Pediatric Cardiology, Texas Children's Hospital, Houston.

BACKGROUND. Balloon-expandable stents (Johnson and Johnson Interventional Systems) have been in use for congenital heart disease since late 1989. They have made possible treatment in previously untreatable branch pulmonary artery stenoses and systemic venous stenosis. The purpose of this report is to detail the results and intermediate-term follow-up of stents used for treatment of congenital heart disease. METHODS AND RESULTS. Eighty-five patients underwent placement of 121 stents in Houston and Boston. Fifty-eight patients had stents put in pulmonary arteries, nine had stents in conduits or outflow tracts, and 21 had stents in venous stenoses or narrowed Fontan anastomoses. (Three patients had stents in two locations.) These stent procedures resulted in gradient reduction from 55.2 +/- 33.3 to 14.2 +/- 13.5 mm Hg in pulmonary arteries, from 41.4 +/- 26.0 to 20.7 +/- 17.0 mm Hg in conduits or outflow tracts, and from 9.8 +/- 6.9 to 2.4 +/- 3.1 mm Hg in venous stenoses or Fontan anastomoses. Diameter of narrowings increased from 4.6 +/- 2.3 to 11.3 +/- 3.2 mm in the pulmonary artery, from 8.8 +/- 3.6 to 12.7 +/- 2.6 in conduits, and from 3.8 +/- 2.9 to 11.3 +/- 2.8 in venous stenoses. Follow-up has shown stent fracture in one patient, restenosis in one, and sudden death in one. Recatheterization has been done in 38 patients an average of 8.6 months after stent installation. Compared with immediately postimplant data, there was no significant change in luminal diameter or pressure gradient. Redilation was performed in 14 patients (17 stents) 1 week to 24 months after implantation (mean, 10.2 months), with a small but significant increase in stenosis diameter. CONCLUSIONS. We conclude that stent treatment of vascular stenoses in congenital heart disease retains efficacy at medium-term follow-up and offers a much-improved outlook for patients with these lesions.

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				J. Maglione, L. Bergersen, J. E. Lock, and D. B. McElhinney Ultra-High-Pressure Balloon Angioplasty for Treatment of Resistant Stenoses Within or Adjacent to Previously Implanted Pulmonary Arterial Stents Circ Cardiovasc Interv, February 1, 2009; 2(1): 52 - 58. [Abstract] [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): e143 - e263. [Full Text] [PDF]

				Z. M. Hijazi and S. M. Awad Pediatric Cardiac Interventions J. Am. Coll. Cardiol. Intv., December 1, 2008; 1(6): 603 - 611. [Abstract] [Full Text] [PDF]

				J. F. Rhodes, Z. M. Hijazi, and R. J. Sommer Pathophysiology of Congenital Heart Disease in the Adult, Part II: Simple Obstructive Lesions Circulation, March 4, 2008; 117(9): 1228 - 1237. [Full Text] [PDF]

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				P Ewert, S Schubert, B Peters, H Abdul-Khaliq, N Nagdyman, and P E Lange The CP stent--short, long, covered--for the treatment of aortic coarctation, stenosis of pulmonary arteries and caval veins, and Fontan anastomosis in children and adults: an evaluation of 60 stents in 53 patients Heart, July 1, 2005; 91(7): 948 - 953. [Abstract] [Full Text] [PDF]

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				C Duke, E Rosenthal, and S A Qureshi The efficacy and safety of stent redilatation in congenital heart disease Heart, August 1, 2003; 89(8): 905 - 912. [Abstract] [Full Text] [PDF]

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				P. Bonhoeffer, Y. Boudjemline, S. A. Qureshi, J. Le Bidois, L. Iserin, P. Acar, J. Merckx, J. Kachaner, and D. Sidi Percutaneous insertion of the pulmonary valve J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1664 - 1669. [Abstract] [Full Text] [PDF]

				T. Kuehne, M. Saeed, G. Reddy, H. Akbari, K. Gleason, D. Turner, D. Teitel, P. Moore, and C. B. Higgins Sequential Magnetic Resonance Monitoring of Pulmonary Flow With Endovascular Stents Placed Across the Pulmonary Valve in Growing Swine Circulation, November 6, 2001; 104(19): 2363 - 2368. [Abstract] [Full Text] [PDF]

				M. A. Hamdan, S. Maheshwari, J. T. Fahey, and W. E. Hellenbrand Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1518 - 1523. [Abstract] [Full Text] [PDF]

				M Peuster, P Wohlsein, M Brugmann, M Ehlerding, K Seidler, C Fink, H Brauer, A Fischer, and G Hausdorf A novel approach to temporary stenting: degradable cardiovascular stents produced from corrodible metal---results 6-18 months after implantation into New Zealand white rabbits Heart, November 1, 2001; 86(5): 563 - 569. [Abstract] [Full Text] [PDF]

				T. P. DOYLE, J. E. LOYD, and I. M. ROBBINS Percutaneous Pulmonary Artery and Vein Stenting . A Novel Treatment for Mediastinal Fibrosis Am. J. Respir. Crit. Care Med., August 15, 2001; 164(4): 657 - 660. [Abstract] [Full Text] [PDF]

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				D A Harrison, P R McLaughlin, C Lazzam, M Connelly, and L N Benson Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up Heart, May 1, 2001; 85(5): 561 - 566. [Abstract] [Full Text]

				R. M. Ungerleider, T. A. Johnston, M. P. O'Laughlin, J. J. Jaggers, and P. R. Gaskin Intraoperative stents to rehabilitate severely stenotic pulmonary vessels Ann. Thorac. Surg., February 1, 2001; 71(2): 476 - 481. [Abstract] [Full Text] [PDF]

				F. F. Ing, T. E. Fagan, R. G. Grifka, S. Clapp, M. R. Nihill, M. Cocalis, J. Perry, J. Mathewson, and C. E. Mullins Reconstruction of stenotic or occluded iliofemoral veins and inferior vena cava using intravascular stents: re-establishing access for future cardiac catheterization and cardiac surgery J. Am. Coll. Cardiol., January 1, 2001; 37(1): 251 - 257. [Abstract] [Full Text] [PDF]

				B. Funaki, J. D. Rosenblum, J. A. Leef, G. X. Zaleski, T. Farrell, J. Lorenz, and L. Brady Percutaneous Treatment of Portal Venous Stenosis in Children and Adolescents with Segmental Hepatic Transplants: Long-term Results Radiology, April 1, 2000; 215(1): 147 - 151. [Abstract] [Full Text]

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				J. L. Fidler, J. P. Cheatham, S. E. Fletcher, A. B. Martin, J. D. Kugler, C. H. Gumbiner, and D. A. Danford CT Angiography of Complications in Pediatric Patients Treated with Intravascular Stents Am. J. Roentgenol., February 1, 2000; 174(2): 355 - 359. [Abstract] [Full Text] [PDF]

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				N Sreeram, P Hutter, and E Silove Sustained high pressure double balloon angioplasty of calcified conduits Heart, February 1, 1999; 81(2): 162 - 165. [Abstract] [Full Text]

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