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Erschienen in: Pediatric Cardiology 3/2007

01.06.2007 | ORIGINAL ARTICLE

Stent Angioplasty: An Effective Alternative in Selected Infants with Critical Native Aortic Coarctation

verfasst von: J. Al-Ata, A. M. Arfi, A. Hussain, A. Kouatly, M. O. Galal

Erschienen in: Pediatric Cardiology | Ausgabe 3/2007

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Abstract

Management of native aortic coarctation during early months of life poses therapeutic challenges, and there is no consensus among medical professionals regarding a management plan. Much can be argued about the benefits, limitations, and/or complications of transcatheter versus surgical intervention in such cases. Occasionally, the complexity of the lesions limits management options. Therefore, each patient requires individual management decisions because there is no one therapeutic plan that satisfies all patients. In this report, four critically ill infants who had complex native coarctation are presented. Surgical repair was not possible because of relative contraindications. The patients underwent transcatheter stent implantation (six procedures and seven stents) as a nondefinitive procedure with acceptable results. Three patients improved. One patient did not survive, mainly due to other major complications. Multiple reexpansions of the stents were carried out when indicated. After a mean follow-up of 45 months (range, 41–49), the three survivors were doing fine and had gained an average weight of 9.7 kg (range, 6.6–13.3). At the time of reporting, the relative contraindications no longer exist and the final surgical repair can be carried out. Our experience suggests that in certain situations and in critically ill infants with complex form of coarctation, stent angioplasty can be used as a life-saving palliative procedure. Further reexpansions can be done when required. This may serve as a bridge to major surgical repair in the future.
Literatur
1.
Zurück zum Zitat Brandt B 3rd, Marvin WJ Jr, Rose EF, Mahoney LT (1987) Surgical treatment of coarctation of the aorta after balloon angioplasty. J Thorac Cardiovasc Surg 94:715–719PubMed Brandt B 3rd, Marvin WJ Jr, Rose EF, Mahoney LT (1987) Surgical treatment of coarctation of the aorta after balloon angioplasty. J Thorac Cardiovasc Surg 94:715–719PubMed
2.
Zurück zum Zitat Ebeid MR, Prieto LR, Latson LA (1997) Use of balloon-expandable stents for coarctation of the aorta: initial results and intermediate-term follow up. J Am Coll Cardiol 30:1847–1852PubMedCrossRef Ebeid MR, Prieto LR, Latson LA (1997) Use of balloon-expandable stents for coarctation of the aorta: initial results and intermediate-term follow up. J Am Coll Cardiol 30:1847–1852PubMedCrossRef
3.
Zurück zum Zitat Fletcher SE, Nihill MR, Grifka RG, O’Laughlin MP, Mullins CE (1995) Balloon angioplasty of native coarctation of the aorta: mid-term follow up and prognostic factors. J Am Coll Cardiol 25:730–734PubMedCrossRef Fletcher SE, Nihill MR, Grifka RG, O’Laughlin MP, Mullins CE (1995) Balloon angioplasty of native coarctation of the aorta: mid-term follow up and prognostic factors. J Am Coll Cardiol 25:730–734PubMedCrossRef
4.
Zurück zum Zitat Fontes VF, Esteves CA, Braga SL, et al. (1990) It is valid to dilate native aortic coarctation with a balloon catheter. Int J Cardiol 27:311–318PubMedCrossRef Fontes VF, Esteves CA, Braga SL, et al. (1990) It is valid to dilate native aortic coarctation with a balloon catheter. Int J Cardiol 27:311–318PubMedCrossRef
5.
Zurück zum Zitat Fyler DC, Buckley LP, Hellenbrand WE (1980) Report of the New England regional infant cardiac program. Pediatric 65:432–436 Fyler DC, Buckley LP, Hellenbrand WE (1980) Report of the New England regional infant cardiac program. Pediatric 65:432–436
6.
Zurück zum Zitat Galal MO, Schmaltz AA, Joufan M, et al. (2003) Balloon dilation of native coarctation in infancy. Z Kardiol 92:735–741PubMedCrossRef Galal MO, Schmaltz AA, Joufan M, et al. (2003) Balloon dilation of native coarctation in infancy. Z Kardiol 92:735–741PubMedCrossRef
7.
Zurück zum Zitat Galal O, Gometza B, al-Halees Z, et al.(1990) Short- and long-term problems in dilatation of untreated aortic isthmus stenosis in children. Z Kardiol 79:518–522PubMed Galal O, Gometza B, al-Halees Z, et al.(1990) Short- and long-term problems in dilatation of untreated aortic isthmus stenosis in children. Z Kardiol 79:518–522PubMed
8.
Zurück zum Zitat Grifka RG, Vick W III, O’Laughlin MP (1993) Balloon expandable intravascular stents: aortic implantation and late further dilation in growing minipigs. Am Heart J 126:979–984PubMedCrossRef Grifka RG, Vick W III, O’Laughlin MP (1993) Balloon expandable intravascular stents: aortic implantation and late further dilation in growing minipigs. Am Heart J 126:979–984PubMedCrossRef
9.
Zurück zum Zitat Ho SY, Anderson RH (1979) Coarctation, tubular hypoplasia and the ductus arteriosus. Histological study of 35 specimens. Br Heart J 41:268–274PubMed Ho SY, Anderson RH (1979) Coarctation, tubular hypoplasia and the ductus arteriosus. Histological study of 35 specimens. Br Heart J 41:268–274PubMed
10.
Zurück zum Zitat Lababidi Z (1992) Percutaneous balloon coarctation angioplasty: long term results. J Interv Cardiol 5:57–62PubMed Lababidi Z (1992) Percutaneous balloon coarctation angioplasty: long term results. J Interv Cardiol 5:57–62PubMed
11.
Zurück zum Zitat Lababidi ZA, Daskalopoulos DA, Stoeckle H Jr (1984) Transluminal balloon coarctation angioplasty: experience with 27 patients. Am J Cardiol 54:1288–1291PubMedCrossRef Lababidi ZA, Daskalopoulos DA, Stoeckle H Jr (1984) Transluminal balloon coarctation angioplasty: experience with 27 patients. Am J Cardiol 54:1288–1291PubMedCrossRef
12.
Zurück zum Zitat Martin ML, Adams MM, Mortensen ML (1990) Descriptive epidemiology of selected malformations of the aorta, Atlanta, 1970–1983. Teratology 42:273–283PubMedCrossRef Martin ML, Adams MM, Mortensen ML (1990) Descriptive epidemiology of selected malformations of the aorta, Atlanta, 1970–1983. Teratology 42:273–283PubMedCrossRef
13.
Zurück zum Zitat Marvin WJ, Mahoney LT, Rose EF (1986) Pathological sequelae of balloon dilation angioplasty for unoperated coarctation of the aorta in children. J Am Coll Cardiol 7:117A Marvin WJ, Mahoney LT, Rose EF (1986) Pathological sequelae of balloon dilation angioplasty for unoperated coarctation of the aorta in children. J Am Coll Cardiol 7:117A
14.
Zurück zum Zitat Merrill WH, Hoff SJ, Stewart JR, et al.(1994) Operative risk factors and durability of repair of coarctation of the aorta in the neonate. Ann Thorac Surg 58:399–403PubMedCrossRef Merrill WH, Hoff SJ, Stewart JR, et al.(1994) Operative risk factors and durability of repair of coarctation of the aorta in the neonate. Ann Thorac Surg 58:399–403PubMedCrossRef
15.
Zurück zum Zitat Morrow WR, Palmaz J, Tio FO, et al.(1993) Re-expansion of balloon-expandable stents after growth. J Am Coll Cardiol 22:2007–2013PubMedCrossRef Morrow WR, Palmaz J, Tio FO, et al.(1993) Re-expansion of balloon-expandable stents after growth. J Am Coll Cardiol 22:2007–2013PubMedCrossRef
16.
Zurück zum Zitat Patel HT, Madani A, Paris YM, Warner KG, Hijazi ZM (2001) Balloon angioplasty of native coarctation of the aorta in infants and neonates: is it worth the hassle? Pediatr Cardiol 22:53–57PubMedCrossRef Patel HT, Madani A, Paris YM, Warner KG, Hijazi ZM (2001) Balloon angioplasty of native coarctation of the aorta in infants and neonates: is it worth the hassle? Pediatr Cardiol 22:53–57PubMedCrossRef
17.
Zurück zum Zitat Quaegebeur JM, Jonas RA, Weinberg AD, Blackstone EH, Kirklin JW (1994) Outcomes in seriously ill neonates with coarctation of aorta. A multiinstitutional study. J Thorac Cardiovasc Surg 108:841–851PubMed Quaegebeur JM, Jonas RA, Weinberg AD, Blackstone EH, Kirklin JW (1994) Outcomes in seriously ill neonates with coarctation of aorta. A multiinstitutional study. J Thorac Cardiovasc Surg 108:841–851PubMed
18.
Zurück zum Zitat Radtke WA, Waller BR, Hebra A, Bradley SM (2002) Palliative stent implantation for aortic coarctation in premature infants weighing <1500 g. Am J Cardiol 90:1409–1412PubMedCrossRef Radtke WA, Waller BR, Hebra A, Bradley SM (2002) Palliative stent implantation for aortic coarctation in premature infants weighing <1500 g. Am J Cardiol 90:1409–1412PubMedCrossRef
19.
Zurück zum Zitat Rao PS (1993) Balloon angioplasty of native aortic coarctation. In: Transcatheter Therapy in Pediatric Cardiology. Wily-Liss, New York, pp 153–196 Rao PS (1993) Balloon angioplasty of native aortic coarctation. In: Transcatheter Therapy in Pediatric Cardiology. Wily-Liss, New York, pp 153–196
20.
Zurück zum Zitat Rao PS, Chopra PS (1991) Role of balloon angioplasty in the treatment of aortic coarctation. Ann Thorac Surg 52:621–631PubMedCrossRef Rao PS, Chopra PS (1991) Role of balloon angioplasty in the treatment of aortic coarctation. Ann Thorac Surg 52:621–631PubMedCrossRef
21.
Zurück zum Zitat Rao PS, Waterman B (1998) Relation of biophysical response of coarcted aortic segment to balloon dilatation with development of recoarctation following balloon angioplasty of native coarctation. Heart 79:407–411PubMed Rao PS, Waterman B (1998) Relation of biophysical response of coarcted aortic segment to balloon dilatation with development of recoarctation following balloon angioplasty of native coarctation. Heart 79:407–411PubMed
22.
Zurück zum Zitat Rao PS, Wilson AD, Brazy J (1992) Transumbilical balloon coarctation angioplasty in neonates with critical aortic coarctation. Am Heart J 124:1622–1624PubMedCrossRef Rao PS, Wilson AD, Brazy J (1992) Transumbilical balloon coarctation angioplasty in neonates with critical aortic coarctation. Am Heart J 124:1622–1624PubMedCrossRef
23.
Zurück zum Zitat Redington AN, Booth P, Shore DF, Rigby ML (1990) Primary balloon dilatation of coarctation in neonates. Br Heart J 64:277–281PubMed Redington AN, Booth P, Shore DF, Rigby ML (1990) Primary balloon dilatation of coarctation in neonates. Br Heart J 64:277–281PubMed
24.
Zurück zum Zitat Rubay JE, Sluysmans T, Alexandrescu V, et al. (1992) Surgical repair of coarctation of the aorta in infants under one year of age. Long-term results in 146 patients comparing subclavian flap angioplasty and modified end-to-end anastomosis. J Cardiovasc Surg (Torino) 33:216–222 Rubay JE, Sluysmans T, Alexandrescu V, et al. (1992) Surgical repair of coarctation of the aorta in infants under one year of age. Long-term results in 146 patients comparing subclavian flap angioplasty and modified end-to-end anastomosis. J Cardiovasc Surg (Torino) 33:216–222
25.
Zurück zum Zitat Russell GA, Berry PJ, Watterson K, Dhasmana JP, Wisheart JD (1991) Patterns of ductal tissue in coarctation of the aorta in the first three months of life. J Thorac Cardiovasc Surg 102:596–601PubMed Russell GA, Berry PJ, Watterson K, Dhasmana JP, Wisheart JD (1991) Patterns of ductal tissue in coarctation of the aorta in the first three months of life. J Thorac Cardiovasc Surg 102:596–601PubMed
26.
Zurück zum Zitat Salahuddin N, Wilson AD, Rao PS (1991) An unusual presentation of coarctation of the aorta in infancy: role of balloon angioplasty in the critically ill infant. Am Heart J 122:1772–1775PubMedCrossRef Salahuddin N, Wilson AD, Rao PS (1991) An unusual presentation of coarctation of the aorta in infancy: role of balloon angioplasty in the critically ill infant. Am Heart J 122:1772–1775PubMedCrossRef
27.
Zurück zum Zitat Suarez de lezo J, Pan M, Romero M, et al. (1995) Balloon-expandable stent repair of severe coarctation of aorta. Am Heart J 129:1002–1008CrossRef Suarez de lezo J, Pan M, Romero M, et al. (1995) Balloon-expandable stent repair of severe coarctation of aorta. Am Heart J 129:1002–1008CrossRef
28.
Zurück zum Zitat Suarez de lezo J, Pan M, Romero M, et al. (1999) Immediate and follow-up findings after stent treatment for severe coarctation of aorta. Am J Cardiol 83:400–406CrossRef Suarez de lezo J, Pan M, Romero M, et al. (1999) Immediate and follow-up findings after stent treatment for severe coarctation of aorta. Am J Cardiol 83:400–406CrossRef
29.
Zurück zum Zitat Suarez de lezo J, Pan M, Romero M, et al. (2005) Percutaneous interventions on severe coarctation of the aorta: a 21-year experience. Pediatr Cardiol 26:176–189CrossRef Suarez de lezo J, Pan M, Romero M, et al. (2005) Percutaneous interventions on severe coarctation of the aorta: a 21-year experience. Pediatr Cardiol 26:176–189CrossRef
30.
Zurück zum Zitat Tamai H, Igaki K, Kyo E, et al. (2000) Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans. Circulation 102:399–404PubMed Tamai H, Igaki K, Kyo E, et al. (2000) Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans. Circulation 102:399–404PubMed
31.
Zurück zum Zitat Treacy EP, Duncan WI, Tyrrel MJ, Lowry NJ (1991) Neurological complications of balloon angioplasty in children. Pediatr Cardiol 12:98–101PubMedCrossRef Treacy EP, Duncan WI, Tyrrel MJ, Lowry NJ (1991) Neurological complications of balloon angioplasty in children. Pediatr Cardiol 12:98–101PubMedCrossRef
32.
Zurück zum Zitat Tynan M, Finley JP, Fontes V, Hess J, Kan J (1990) Balloon angioplasty for the treatment of native coarctation: results of valvuloplasty and angioplasty of Congenital Anomaly Registry. Am J Cardiol 65:790–792PubMedCrossRef Tynan M, Finley JP, Fontes V, Hess J, Kan J (1990) Balloon angioplasty for the treatment of native coarctation: results of valvuloplasty and angioplasty of Congenital Anomaly Registry. Am J Cardiol 65:790–792PubMedCrossRef
Metadaten
Titel
Stent Angioplasty: An Effective Alternative in Selected Infants with Critical Native Aortic Coarctation
verfasst von
J. Al-Ata
A. M. Arfi
A. Hussain
A. Kouatly
M. O. Galal
Publikationsdatum
01.06.2007
Erschienen in
Pediatric Cardiology / Ausgabe 3/2007
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-006-0074-4

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