my personal edition > interventional cardiology > news


  E-Mail this DGDispatch to a colleague

DGDispatch

Wide Inventory of Stents Needed When Placing in Small Children: Presented at SCAI

By Crystal Phend

CHICAGO, I.L. -- May 15, 2006 -- Although pulmonary artery stent implantation can be successful in small children without negatively influencing further surgical options, a wide range of stents and balloons may be required to treat these complex cases, researchers said here at the Society for Cardiovascular Angiography and Interventions annual meeting (SCAI).

"Early pulmonary artery rehabilitation in small children is important to maintain adequate pulmonary arterial growth," but it is quite a challenging task, said lead author Ralf J. Holzer, MD, assistant professor of clinical pediatrics, Ohio State University, Columbus, Ohio, in a presentation May 12^th.

Dr. Holzer discussed the findings of a retrospective study done in 43 children (75 stents) at Columbus Children's Hospital. Overall, more than 5 types of stents and at least 4 types of balloons were used during these procedures.

All the children weighed less than 15 kg (33 lbs) with an average weight of 9.5 kg and an average age of 1.5 years.

Such young patients typically have a high recurrence rate and also frequently need further surgical treatment either to manage restenosis or to expand stents due to growth.

Of the procedures, 23% were status/post (S/P) surgical repair of tetralogy of Fallot or partial atrioventricular septum defect, and 23% were S/P bidirectional Glenn shunts.

The surgeon placed the stent in the left pulmonary artery in 42.7% of cases while 24% were put in the right pulmonary artery, and 12% were implanted in the distal pulmonary artery.

The procedures were typically successful, with a significant improvement in vessel diameter from an average of 2.5 mm at baseline to 7 mm afterward. The systolic gradient across the stenosis significantly improved from an average of 35.5 mm Hg to 5.5 mm Hg.

Adverse events occurred in 26.5% of patients over the average 2.5 years of follow up -- hypotension or brachycardia in 10.2%, pleural effusion in 2%, jailed access to branch pulmonary artery in 6.1%, and 1 patient had vascular complications.

Recatheterizations were done in 18 patients, of which about 30% were preplanned and another 40% prompted by computed tomography or echocardiogram imaging. These were done 280 days after the initial procedure, on average, due to in-stent stenosis in 30% of the children, stent fracture in 1 patient, and to re-expand the stent to allow for growth in 26%.

A substantial proportion of the children had subsequent pulmonary artery surgery (41.8%). In the majority of cases the stent was not touched during this surgery (55.6%), but the stent was completely removed in 38.9%.

"Endovascular stenting is an important treatment modality [for pulmonary artery repair] even in small children," Dr. Holzer said, because it may delay the need for pulmonary artery surgery.


[Presentation title: PA Rehabilitation Using Endovascular Stenting in Children With a Weight Below 15kg: "Stents Are for Kids, Too." Abstract PO-8]

E-Mail this DGDispatch to a colleague

To print, use this version