Stent Angioplasty for Critical Native Aortic Coarctation in Three Infants: Up to 15-Year Follow-Up Without Surgical Intervention and Review of the Literature
- 186 Downloads
Management of neonatal native coarctation is debated till now. Surgical therapy remains an option but may be unwarranted in critically sick infants with complex lesions. Balloon dilatation has been employed but with early re-stenosis. Stent angioplasty has also been used but as a bridge towards definitive surgical therapy. Four critically sick infants with complex coarctation and additional co-morbidity factors underwent primary stent therapy as surgical intervention was denied. One patient had died earlier due to reasons unrelated to the procedure. Three survivors underwent multiple dilatations of primary stents as indicated. One of the three survivors did not require any further dilatation after the age of 5 years and remained stable till the time of reporting. High-pressure Cheatham Platinum stents were implanted inside the primary stents in two infants, who developed re-stenosis due to somatic growth. These stents were further balloon dilated at high atmospheric pressure. Femoral arteries in both of them were blocked but were re-canalized after balloon dilatation in one and stent angioplasty in the other. After a follow-up of about 15 years, all of them have been doing fine with acceptable Doppler gradients. They were normotensive and on no cardiac medications. It can be concluded that, though surgical repair remains a standard of care, stent angioplasty in selected infants with complex lesions is feasible and effective. Multiple dilatations can be performed without added risk of stent migration. Bio-absorbable and growth stents hold a promise for future use in such situations.
KeywordsNeonate Neonatal coarctation Native aortic coarctation Percutaneous balloon dilatation Stent angioplasty Stent dilatation
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interests.
This article does not contain any studies involving human and animal participants performed by any of the authors.
Informed consent, either from patients or parents, was legibly obtained according to the institution policy in whom interventional procedures were performed and who were included in the study.
- 1.Norman S, Talner (1998) Report of the New England Regional Infant Cardiac Program, by Donald C. Fyler. Pediatrics 102:258–259Google Scholar
- 3.Uguz E, Ozkan S, Akay HT, Gultekin B, Aslamaci S (2010) Surgical repair of coarctation of aorta in neonates and infants: a 10 year experience. Turk J Thorac Cardiovasc Surg 18(2):94–99Google Scholar
- 12.Feltes TF, Bacha E, Beekman RH, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM (2011) Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from American Heart association. Circulation 123:2607–26520020CrossRefGoogle Scholar
- 24.Greig C, Buys DG, Brown SC, Smit FE (2014) The use of small stents to delay surgical intervention in very young children with critical congenital heart disease. SA Heart 11:128–134Google Scholar
- 28.Haponiuk I, Chojnicki M, Steffens M, Jaworski R, Szofer-Sendrowska A, Juscinski J, Kwasniak E, Paczkowski K, Zielinski J, Gierat-Haponiuk K (2013) Miniinvasive interventional bridge to major surgical repair of critical aortic coarctation in a newborn with severe multiorgan failure. Wideochir Inne Tech Maloinwazyjne 8:244–248PubMedPubMedCentralGoogle Scholar
- 31.Forbes TJ1, Moore P, Pedra CA, Zahn EM, Nykanen D, Amin Z, Garekar S, Teitel D, Qureshi SA, Cheatham JP, Ebeid MR, Hijazi ZM, Sandhu S, Hagler DJ, Sievert H, Fagan TE, Ringwald J, Du W, Tang L, Wax DF, Rhodes J, Johnston TA, Jones TK, Turner DR, Pass R, Torres A, Hellenbrand WE (2007) Intermediate follow up following intravascular stenting for treatment of coarctation of aorta. Catheter Cardiovasc Interv 70:569–577CrossRefGoogle Scholar
- 34.Forbes TJ, Garekar S, Amin Z, Zahn EM, Nykanen D, Moore P, Qureshi SA, Cheatham JP, Ebeid MR, Hijazi ZM, Sandhu S, Hagler DJ, Sievert H, Fagan TE, Ringewald J, Du W, Tang L, Wax DF, Rhodes J, Johnston TA, Jones TK, Turner DR, Pedra CA, Hellenbrand WE, Congenital Cardiovascular Interventional Study Consortium (CCISC). (2007) Procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age: a multi-institutional study. Catheter Cardiovasc Interv 70:276–285Google Scholar