Initial experience using the Palmaz Corinthian stent for right ventricular outflow obstruction in infants and small
D R Turner1, E Rodriguez-Cruz, R D Ross
1Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, USA.
Insights
The new Palmaz Corinthian stent offers a safer alternative for infants and small children with right ventricular outflow obstruction. This flexible stent avoids surgery and complications in high-risk pediatric patients.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- The Palmaz balloon-expandable stent is widely used for vascular stenoses in older children and young adults.
- Stent placement in infants and small children is challenging due to inflexibility, large delivery sheaths, and growth concerns.
Observation:
- Four high-risk infants (5-32 months) with postoperative right ventricular outflow obstruction underwent Palmaz Corinthian stent placement.
- These patients were not candidates for surgical repair.
- Stents were delivered via 6 French sheaths, with a median fluoroscopy time of 58.2 minutes.
Findings:
- Successful stent placement was achieved in all four patients, avoiding surgery and cardiopulmonary bypass.
- No complications were encountered during or after the procedures.
- Palmaz Corinthian stents demonstrated greater flexibility, smaller sheath size, and enhanced expansion capabilities compared to the original Palmaz stent.
Implications:
- The Palmaz Corinthian stent is a viable option for select infants and small children with right ventricular outflow obstruction.
- This approach can prevent the need for surgical repair in high-risk pediatric populations.
- The improved characteristics of the Corinthian stent address limitations of previous models for pediatric use.
Abstract:
The original Palmaz balloon expandable stent has been used extensively for the treatment of vascular stenoses in older children and young adults. Placement of the Palmaz stent in infants and small children, however, is limited by stent inflexibility, large delivery sheath size, and concerns about creating fixed obstructions after the placement of small diameter stents in growing patients. New Palmaz Corinthian stents were placed through 6 French sheaths in four high-risk patients with postoperative right ventricular outflow obstruction. Patients were not considered candidates for surgical repair. Median patient age and weight were 17 months (range 5-32 months) and 7.7 kg (range 4.6-11.1 kg), respectively. Median fluoroscopy time was 58.2 min (range 55.2-172 min). No complications were encountered. In each case, successful stent placement was achieved, and surgery with cardiopulmonary bypass was avoided. Palmaz Corinthian stents are more flexible, require a smaller delivery sheath, have equal or increased radial strength, and can be maximally expanded to a greater cross sectional area when compared to the original Palmaz stent. These characteristics make the Palmaz Corinthian stent a reasonable alternative for use in a select group of infants and small children who are not candidates for surgical repair of postoperative right ventricular outflow obstruction.
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