Stent fractures in congenital heart disease
John P Breinholt1, Alan W Nugent, Mark A Law
1Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Objective:
To describe incidence, characteristics, predictive factors, and sequelae of stent fractures in congenital heart disease.
Background:
Stent fracture in congenital heart disease patients is rarely reported.
Methods:
Patients with stents implanted from 1990 to 2006, with subsequent fluoroscopy were enrolled. Information obtained included: stent type, location, balloon diameter, and residual narrowing. Fracture characteristics, radiographic appearance, and clinical sequelae were also obtained in those with fractures identified.
Results:
: Two hundred and sixty-five patients (583 stents) had fluoroscopy 4.2 +/- 3.3 years after stent implantation. The majority of stents (395, 67.7%) were placed in a pulmonary artery (PA) or its branches. Sixteen stents (2.7%) were placed in a right ventricle to pulmonary artery (RV-PA) conduit. Fourteen fractures (2.4%) were identified 5.0 +/- 3.2 years after implantation: RV-PA conduit 4/16, proximal right PA 4/135, proximal left PA 6/184 (P = 0.003). Identification was primarily made on lateral fluoroscopy. Review of chest radiographs demonstrated fractures in only 71%. In fractured PA stents, five were redilated and three had additional stents placed. Of the four conduit stent fractures: one underwent redilation, one had embolized segments, and one was reinforced with a second stent that also fractured and embolized a segment during redilation at a later catheterization. All fractures were asymptomatic.
Conclusions:
With the exception of RV-PA conduit stents, fracture is rare and asymptomatic. PA stent fractures occurred in 2.5% and did not embolize, whereas RV-PA conduit stent fractures were significantly more common and may embolize.
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