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[The role of the stent in non-coronary cardiopathies]
R Bermúdez-Cañete1, I Herráiz Sarachaga, A Salgado
1Servicio de Cardiología, Hospital Ramón y Cajal, Madrid.
Insights
Stenting effectively treats stenotic lesions in pediatric congenital heart defects, improving blood flow and reducing pressure. This minimally invasive approach offers a safe alternative to surgery for complex vascular issues.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Stenting is a proven method for preventing postangioplasty coronary restenosis.
- Stents are being explored as a treatment for stenotic lesions in arteries and veins related to congenital defects.
Purpose of the Study:
- To evaluate the efficacy and safety of stenting in pediatric patients with congenital vascular defects.
- To analyze the clinical experience with stenting in complex pediatric cardiovascular cases.
Main Methods:
- 28 stenting procedures were performed in 26 pediatric patients (mean age 8.6 years).
- Stents were placed in pulmonary artery branches, right ventricular outflow tract, systemic veins, and post-Mustard atrial channels.
- Most patients had a history of prior surgical interventions.
Main Results:
- Significant increase in stenotic lesion diameter (4.4 to 11.6 mm) and decrease in transtenotic gradient (38.1 to 12 mmHg).
- Reduction in right ventricular pressure observed in patients with pulmonary branch stenosis.
- No mortality directly related to percutaneous treatment; one patient required subsequent surgery.
Conclusions:
- Stenting is an effective alternative or adjunct to balloon angioplasty for stenotic lesions in the pulmonary tree, systemic veins, and intraatrial channels.
- Stenting provides a valuable and safe option when surgery is high-risk or not feasible.
Introduction:
The stent has demonstrated to be a useful device in the prevention of postangioplasty coronary restenosis and it is expected to have a favourable effect as an alternative or complementary treatment of stenotic lesions in arteries or veins associated with congenital defects. The aim of this study is to analyze our experience in this setting.
Material And Methods:
From February 1992 to March 1996, 28 stenting procedures were performed in 26 patients (mean age: 8.6 +/- 0.7 years; mean weight: 26.2 +/- 3 kg). In 12 patients, stenting was single, and a iliac Palmaz stents were always used. Stenting location was: pulmonary artery branches in 17 patients, right ventricular outflow in 2 patients, in the junction of right atrium with pulmonary artery in 2 patients, systemic veins in 2 patients and in post Mustard intratrial channel stenosis in 2 patients. 25 patients had previously undergone at least one surgical procedure.
Results:
The stenotic diameter of the treated lesions increased significantly after the procedure (4.4 +/- 0.3 mm before stenting vs 11.6 +/- 0.3 mm after stenting, p < 0.0001) and the transtenotic gradient decreased from 38.1 +/- 5 to 12 +/- 3.8 mmHg. Those changes were associated with a diminution of right ventricular pressure (81.6 +/- 3 vs 56.7 +/- 6 mmHg, p < 0.0001) in patients with pulmonary branch stenosis without septal defects. There was no mortality among the percutaneously treated patients and only one patient needed surgery. Nevertheless, one patient died after bilateral intraoperative stenting.
Conclusion:
The treatment of proximal or distal stenotic lesions in the pulmonary tree, systemic veins, and obstructed intraatrial channels with stents, can replace or complement conventional balloon angioplasty. It also offers a useful and effective alternative to surgery, when it is impossible or carries a risk.