Stent implantation in the youngest patients with a congenital heart disease implicates limitations concerning further vessel growth, the need of staged redilation, and later surgical removal The search to overcome these restrictions led to open stent designs, with a wide adaptability to the vessel growth and recently to the development of bioabsorbable stent materials A preterm baby born at 26 weeks of gestation was referred to our clinic following inadvertent ligation of the left pulmonary artery Despite efficient debanding, the left lung perfusion was absent Implantation of a biodegradable 3 mm magnesium stent was performed in a hybrid procedure when the baby weighed 17 kg Reperfusion of the left lung was established and persisted throughout the 4-month follow-up period during which the gradual degradation process of the stent completed Additional interventions, should they become necessary, seem not to be limited Despite the small size of the baby, the degradation process was clinically well tolerated The mechanical and degradation characteristics of the magnesium stent proved to be adequate to secure reperfusion of the previously occluded left pulmonary artery Bioabsorbable stents with different diameters may help develop new strategies in the therapy of vessel stenosis in pediatric patients

First successful implantation of a biodegradable metal stent into the left pulmonary artery of a preterm baby

Objectives: To assess the extent of neointimal proliferation and the safety and efficacy of stent redilatation in patients with stents implanted for aortic coarctation or branch pulmonary artery stenosis.

Design: Retrospective observational study.

Setting: Tertiary referral centre.

Patients and interventions: Of 60 patients with Palmaz stents, 12 with coarctation and 12 with branch pulmonary artery stenosis (with 21 stented sites) underwent recatheterisation and stent redilatation.

Results: Neointimal thickening > 1 mm was detected in six of the 12 coarctation stents and at nine of the 21 stented sites in branch pulmonary arteries (five of which had been overdilated at implantation). Eight of the coarctation stents were electively underdilated at implantation. Coarctation stent redilatation increased median (range) lumen diameter from 9.2 (6.3–11.1) mm to 11.7 (9.8–14.1) mm (p = 0.002), decreased gradient from 10.5 (0–20) mm Hg to 0.5 (0–15) mm Hg (p = 0.008), and increased the ratio of stent diameter to descending aorta diameter from 0.66 (0.38–1.02) to 0.85 (0.52–1.2) (p = 0.008). Pulmonary artery stent redilatation increased lumen diameter from 6.9 (3.8–13.5) mm to 8.8 (4.8–14.1) mm (p < 0.001), decreased gradient from 24 (2–62) mm Hg to 12 (0–29) mm Hg (p < 0.001), and increased the ratio of stent diameter to diameter of distal pulmonary artery from 0.66 (0.44–1.5) to 0.86 (0.48–1.88) (p = 0.001). Dilatation of one peripheral pulmonary artery stent resulted in rupture of the vessel distal to the stent.

Conclusions: Neointimal proliferation is precipitated by overdilating stents at implantation. Redilatation using balloons matched to distal vessel diameter increases stent lumen size, but may not optimise vessel diameter. Redilatation is effective whether the indication for redilatation is a resistant stenosis at implantation, underexpansion at implantation, neointimal proliferation, or relative stenosis caused by growth.

https://heart.bmj.com/content/heartjnl/89/8/905.full.pdf

The efficacy and safety of stent redilatation in congenital heart disease.

Pulmonary artery trauma due to balloon dilation: recognition, avoidance and management.

There is limited reported experience of catheterization therapy for peripheral pulmonary stenosis (PPS) at a surgical site in the early postoperative period. We reviewed the clinical course of patients undergoing interventional catheterization for PPS at a surgical site 50% increase in predilation diameter. From 1984 to 2000, 17 patients had 19 proximal pulmonary arteries dilated 1 to 46 (median 8) days postoperatively. Median age and weight were 3.1 year and 12.7 kg. Three arteries were initially occluded. Seventeen arteries had initial BD with postintervention imaging available in 15; 8 arteries had SD. The arterial diameter increased from 3.9 ± 2.6 to 5.5 ± 2.8 mm (P < 0.001). Nine of these arteries had stents placed with diameter increasing to 8.7 ± 3.7 mm (P < 0.001 compared with post-BD diameter). Stents increased the diameter in all arteries and made four of four failed BD successful. In the two most recent procedures, stents were placed without prior BD with diameter increasing from 1.3 to 9 mm and 8.2 to 14 mm. A stent was placed in 1 of 7 arteries prior to 1993 and in 10 of 12 arteries thereafter (P < 0.004). Three patients prior to 1995 had catheterization-related deaths secondary to vessel rupture after BD. BD produces SD in approximately one-half of the procedures but is associated with mortality. Stent placement increases vessel diameter substantially more than BD alone. Stents reduce the acute complication rate and avoid early reoperation in this patient group. Cathet Cardiovasc Intervent 2002;56:272–277. © 2002 Wiley-Liss, Inc.

Interventional catheterization management of perioperative peripheral pulmonary stenosis: balloon angioplasty or endovascular stenting.

Early and intermediate-term complications of self-expanding stents limit its potential application in children with congenital heart disease.

Our objective was to assess the immediate and short-term results of stent implantation to relieve pulmonary artery stenosis (PAS). Thirty-seven patients underwent an attempt at stent implantatlon at a medlan age of 7.0 years (range, 0.G31.4 years) and a median weight of 20.5 kg (range, 7.4-85 kg). Twenty-two patients had previous tetralogy of Fallot repair. A total of 55 stents were Implanted successfully in 36 patlents. The peak systolic gradient across the stenotic segment decreased from a mean of 43 2 20.4 mmHg prestent to 13 f 13.9 mmHg (P a:: 0.001) poststent. The diameter of the narrowest segment Increased from a mean of 4.8 f 1.6 mm to 10.5 f 2.6 mm (P ,:I 0,001). The right ventrlcular-to-aortic mean systolic pressure ratio decreased from 0.74 2 0.2 to 0.52 ? 0.1 9 (P c: 0.001). Complications included balloon rupture prior to full stent expansion in 4 patients (in 2 patients the stent was positioned in the superior vena cava, and in 2 in the inferior vena cava), distal migration of a stent which was successfully retrieved at surgery 1 mo later in 1 patient, and tethering of the stent to the balloon requiring surgical removal in 1 patient. One patient died several hours after stent placement. Sixteen patients underwent repeat catheterization at a mean follow-up interval 010.9 * 0.5years (range, 0.2-2.0years). The mean gradient across the stent for these 16 patients was 26.7 f 19.8 mmHg, and there was no change in the mean diameter (9.4 2 3.2 mm). Two patients developed stenosis related to neointimal proliferation at the stent site which was redilated successfully. In conclusion, stent irnplantation is generally safe and effective in relleving PAS. c 1996 WIIO~-LI~~. Inc

Stent implantation for relief of pulmonary artery stenosis: immediate and short-term results.

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Stent implantation for relief of pulmonary artery stenosis: immediate and short-term results.