Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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The outcome of percutaneous stent implantation in congenital heart disease: experience of a single institute

  • Kim, Moon Sun (Department of Pediatrics, Sejong General Hospital) ;
  • Yoon, Ja Kyoung (Department of Pediatrics, Sejong General Hospital) ;
  • Kim, Seong Ho (Department of Pediatrics, Sejong General Hospital) ;
  • Bang, Ji Seok (Department of Pediatrics, Sejong General Hospital) ;
  • Jang, So Ick (Department of Pediatrics, Sejong General Hospital) ;
  • Lee, Sang Yoon (Department of Pediatrics, Sejong General Hospital) ;
  • Choi, Eun Young (Department of Pediatrics, Sejong General Hospital) ;
  • Park, Su Jin (Department of Pediatrics, Sejong General Hospital) ;
  • Kwon, Hye Won (Department of Pediatrics, Sejong General Hospital)
  • Received : 2017.09.14
  • Accepted : 2017.10.27
  • Published : 2018.06.15
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Abstract

Purpose: The efficacy of percutaneous stent implantation for congenital heart disease (CHD) in Korea, where stent availability is limited, has not been determined. This study evaluated the acute and midterm results of stent implantation in different CHD subgroups. Methods: Stents were implanted in 75 patients with 81 lesions: (1) pulmonary artery stenosis (PAS) group, 56 lesions in 51 patients; (2) coarctation of the aorta (CoA) group, 5 lesions in 5 patients; (3) Fontan group, 13 lesions in 12 patients; (4) ductal stent group, 3 lesions in 3 patients; and (5) other CHD group, 4 lesions in 4 patients. Mean follow-up duration was 2.1 years (0.1-4 years). Medical records were reviewed retrospectively. Results: The minimum lumen diameter (MLD) in PAS and CoA increased from $5.0{\pm}1.9mm$ and $8.4{\pm}1.6mm$ to $10.1{\pm}3.6mm$ and $12.3{\pm}2.5mm$, respectively (P<0.01). In the PAS group, pressure gradient decreased from $25.7{\pm}15.6mmHg$ to $10.4{\pm}10.1mmHg$, and right ventricular to aortic pressure ratio from $0.56{\pm}0.21$ to $0.46{\pm}0.19$. In the CoA group, the pressure gradient decreased from $50{\pm}33mmHg$ to $17{\pm}8mmHg$. In the ductal stent group, the MLD of the ductus increased from 2.3 mm to 4.3 mm and arterial oxygen saturation from 40%-70% to 90%. No deaths were associated with stent implantation. Stent migration occurred in 3 patients, but repositioning was successful in all. Stent redilation was performed successfully in 26 cases after $29{\pm}12months$. Conclusion: Percutaneous stent implantation was safe and effective, with acceptable short and mid-term outcomes in Korean CHD patients.

Keywords

References

  1. Shaffer KM, Mullins CE, Grifka RG, O'Laughlin MP, McMahon W, Ing FF, et al. Intravascular stents in congenital heart disease: short­ and long­term results from a large single­center experience. J Am Coll Cardiol 1998;31:661-­7. https://doi.org/10.1016/S0735-1097(97)00535-4
  2. Tomita H, Nakanishi T, Hamaoka K, Kobayashi T, Ono Y. Stenting in congenital heart disease: medium­ and long­term outcomes from the JPIC stent survey. Circ J 2010;74:1676-­83. https://doi.org/10.1253/circj.CJ-10-0157
  3. Law MA, Breinholt JP 3rd, Shamszad P, Justino H, Mullins CE, Ing FF. The outcome of pulmonary artery stents following surgical mani­ pulation. Catheter Cardiovasc Interv 2011;77:390-­4. https://doi.org/10.1002/ccd.22694
  4. Ko HK, Kim YH, Yu JJ, Ko JK, Park IS, Seo DM, et al. Effectiveness and safety of percutaneous transcatheter implantation of pulmonary arterial stent in congenital heart disease. Korean Circ J 2012;42:40-5. https://doi.org/10.4070/kcj.2012.42.1.40
  5. Kim SH. Pulmonary artery stents­still "off label". Korean Circ J 2012;42:8-­9. https://doi.org/10.4070/kcj.2012.42.1.8
  6. Lewis MJ, Kennedy KF, Ginns J, Crystal MA, Torres A, Vincent J, et al. Procedural success and adverse events in pulmonary artery stenting: insights from the NCDR. J Am Coll Cardiol 2016;67:1327­-35.
  7. O'Laughlin MP, Slack MC, Grifka RG, Perry SB, Lock JE, Mullins CE. Implantation and intermediate­term follow­up of stents in congenital heart disease. Circulation 1993;88:605­-14. https://doi.org/10.1161/01.CIR.88.2.605
  8. O'Laughlin MP, Perry SB, Lock JE, Mullins CE. Use of endovascular stents in congenital heart disease. Circulation 1991;83:1923­-39. https://doi.org/10.1161/01.CIR.83.6.1923
  9. Boe BA, Zampi JD, Schumacher KR, Yu S, Armstrong AK. The use and outcomes of small, medium and large premounted stents in pediatric and congenital heart disease. Pediatr Cardiol 2016;37:1525-33. https://doi.org/10.1007/s00246-016-1466-8
  10. Danon S, Gray RG, Crystal MA, Morgan G, Gruenstein DH, Goldstein BH, et al. Expansion characteristics of stents used in congenital heart disease: serial dilation offers improved expansion potential compared to direct dilation: results from a Pediatric Interventional Cardiology Early Career Society (PICES) investigation. Congenit Heart Dis 2016;11:741-­50. https://doi.org/10.1111/chd.12399
  11. Yeaw X, Murdoch DJ, Wijesekera V, Sedgwick JF, Whight CM, Pohlner PG, et al. Comparison of surgical repair and percutaneous stent implantation for native coarctation of the aorta in patients ${\geq}$ 15 years of age. Int J Cardiol 2016;203:629­-31. https://doi.org/10.1016/j.ijcard.2015.11.052
  12. Khajali Z, Sanati HR, Pouraliakbar H, Mohebbi B, Aeinfar K, Zolfaghari R. Self-­expandable stent for repairing coarctation of the left­circumferential aortic arch with right­sided descending aorta and aberrant right subclavian artery with Kommerell's aneurysm. Ann Vasc Surg 2017;38:318.e7-318.e10. https://doi.org/10.1016/j.avsg.2016.05.116
  13. Mets JM, Bergersen L, Mayer JE Jr, Marshall AC, McElhinney DB. Outcomes of stent implantation for obstruction of intracardiac lateral tunnel Fontan pathways. Circ Cardiovasc Interv 2013;6:92­-100. https://doi.org/10.1161/CIRCINTERVENTIONS.112.000099
  14. Tola HT, Ergul Y, Saygi M, Ozyilmaz I, Guzeltas A, Odemis E. Ductal stent implantation in tetralogy of fallot with aortic arch abnormality. Tex Heart Inst J 2015;42:281­-4. https://doi.org/10.14503/THIJ-13-3373
  15. Michel­Behnke I, Akintuerk H, Thul J, Bauer J, Hagel KJ, Schranz D. Stent implantation in the ductus arteriosus for pulmonary blood supply in congenital heart disease. Catheter Cardiovasc Interv 2004;61:242­52. https://doi.org/10.1002/ccd.10766
  16. Porras D, McElhinney DB, Del Nido P, Lock JE, Meadows J, Marshall AC. Clinical and stent­related outcomes after transcatheter or opera­ tive placement of bare­metal stents in the ventricular septum or subvalvar systemic outflow tract. Circ Cardiovasc Interv 2012;5:570­-81. https://doi.org/10.1161/CIRCINTERVENTIONS.111.967190
  17. Ing FF, Grifka RG, Nihill MR, Mullins CE. Repeat dilation of intra­ vascular stents in congenital heart defects. Circulation 1995;92:893­-7. https://doi.org/10.1161/01.CIR.92.4.893

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