First Report of Atretic Coronary Sinus Stenting in a 5‐kg Infant Resulting in Dramatic Improvement of Ventricular Function in Functional Single Ventricle

The patient was a male infant with L‐transposition of great arteries (L‐TGA), Ebstein's anomaly of the tricuspid valve, subvalvar aortic stenosis, ventricular septal defect (VSD), hypoplastic right ventricle, arch hypoplasia, and congenital complete heart block. He underwent a Norwood procedure, aortic arch repair, permanent pacemaker implantation, and a 3.5‐mm aortopulmonary shunt at 4 days of age. At the time of his surgery, left ventricular function was in the normal range (ejection fraction [EF] = 67%). However by 3 months of age, he was noted to have developed moderate–severe biventricular dysfunction (left ventricular ejection fraction [LVEF] = 34%). Atresia of the coronary sinus with a small left superior venacava (LSVC) and a bridging vein was discovered during cardiac catheterization at this time. The coronary sinus mean pressure was 17 mm Hg, and the common atrial mean pressure was 6 mmHg. We opened the atretic coronary sinus ostium using radiofrequency ablation and stent placement. There was dramatic improvement in ventricular function observed over a 2‐month period. Follow‐up cardiac catheterization 5 months later revealed the stent in the coronary sinus to be widely patent with no intimal buildup, and the ventricular function was normal (LVEF =58%). The patient had a bidirectional Glenn procedure with an uncomplicated postoperative course and is currently awaiting Fontan completion.     

Percutaneous recanalization and balloon angioplasty of congenital isolated local atresia of the aortic isthmus in adults.

Congenital isolated local atresia of the aortic isthmus is anatomically similar and morphogenetically related to congenital coarctation of the aorta and was encountered in 4 out of 26 consecutive adult patients selected for coarctation angioplasty at our center. Anterograde recanalization of the atresia was safely and successfully accomplished in all four patients, using a brachial approach. Balloon dilation in the four patients, with ancillary stent implantation in one patient, resulted in reduction of translesion gradient from 84 +/- 11 mm Hg to 9 +/- 7 mm Hg without complications. Angiography in the three non-stented patients after a mean follow-up of 13 months showed no evidence of restenosis, dissection or aneurysm formation, though one patient had mild dilatation of the posterior aspect of the aortic isthmus. The clinical presentation of patients with isolated local aortic atresia, and their short- to mid-term response to percutaneous treatment, is similar to that of patients with isolated severe coarctation of aorta.     

Intravascular stent prosthesis for right ventricular outflow obstruction.

OBJECTIVES. This study was designed to assess the impact of implantation of balloon-expandable stents on right ventricular outflow obstruction in children with congenital heart disease. BACKGROUND. Intravascular stenting has been established as a useful treatment in adults with coronary and peripheral vascular disease. Its application in the treatment of infants and children with pulmonary, systemic and right ventricular conduit obstruction resistant to balloon angioplasty is limited. METHODS. A total of 24 stainless steel stents were implanted in 17 patients. Five stents were placed within right ventricular to pulmonary artery conduits, 17 in branch pulmonary arteries and 1 in an aortopulmonary collateral vessel. Follow-up time has ranged from 1 to 14 months, with 6 patients having hemodynamic and angiographic studies greater than 1 year after stent placement. The mean age at implantation was 7.4 +/- 5.6 years and the mean weight 33 +/- 16 kg. RESULTS. Optimal stent position was obtained in 22 of 24 implantations. In one patient the stent slipped from the delivery balloon and was left positioned in the inferior vena cava. No embolization or thrombotic event has been documented. Among patients with right ventricular to pulmonary artery conduit obstruction, the gradient was immediately reduced from 85 +/- 30 mm Hg to 35 +/- 20 mm Hg after stent implantation; however, three patients required conduit replacement because of persistent obstruction with elevated right ventricular pressures (82 +/- 16 mm Hg). In 10 of 11 patients with pulmonary artery stenosis, clinical improvement was noted in association with enlargement of vessel diameter by 92% +/- 90% (range 17% to 355%) and the gradient reduction of 22 +/- 24 mm Hg to 3 +/- 4 mm Hg. CONCLUSIONS. These data support the view that intravascular stenting will become an important adjunct in the management of children with congenital heart disease.     

Balloon expandable stent implantation in stenotic right heart valved conduits

Although valved conduits have been used successfully in severe forms of right ventricular-pulmonary artery discontinuity, progressive valved conduit stenosis is an important clinical problem. To determine the feasibility of reducing right heart valved conduit stenosis with a balloon expandable stent, a baboon model was used, in which the pulmonary artery was ligated and a right ventricular to pulmonary artery 14 mm bioprosthetic Dacron valved conduit implanted. In five baboons, at an average of 40 months after valved conduit implantation, fibrointimal stenosis at the valve site resulted in narrowing and a mean transconduit pressure gradient of 49 mm Hg (range 33 to 65). A tubular slotted steel stent (1.2 cm long) was deployed within the valved conduit after inflation of an 8 to 15 mm diameter balloon catheter that was introduced through the femoral vein. A stent was delivered to all valved conduits; however, in two baboons, balloon undersizing resulted in stent dislodgment. In the remaining three baboons, the transconduit gradient was reduced by 59% (49 to 20 mm Hg) and right ventricular systolic pressure decreased acutely by 35% (77 to 50 mm Hg). It is concluded that stent deployment is feasible in right ventricular to pulmonary artery stenotic valved conduits and may result in significant hemodynamic improvement. However, successful stent delivery is critically dependent on the proper selection of stent length and balloon diameter.     

Left recurrent laryngeal nerve palsy following aortic arch stenting: A case report

BACKGROUND Aortic arch stenting is continuously emerging as a safe and effective option to alleviate aortic arch stenosis and arterial hypertension.CASE SUMMARY We present a 15-year-old girl with aortic arch hypoplasia who had undergone implantation of an uncovered 22 mm Cheatham-Platinum stent due to severe(native) aortic arch stenosis. On follow-up seven months later, she presented a significant re-stenosis of the aortic arch. A second stent(LD Max 26 mm) was implanted and both stents were dilated up to 16 mm. After an initially unremarkable post-interventional course, the patient presented with hoarseness five days after the intervention. MRI and CT scans ruled out an intracranial pathology, as well as thoracic hematoma, arterial dissection, and aneurysm around the intervention site. Laryngoscopy confirmed left vocal fold paresis attributable to an injury to the left recurrent laryngeal nerve(LRLN) during aortic arch stenting, as the nerve loops around the aortic arch in close proximity to the area of the implanted stents. Following a non-invasive therapeutic approach entailing regular speech therapy, the patient recovered and demonstrated no residual clinical symptoms of LRLN palsy after six months.CONCLUSION Left recurrent laryngeal nerve palsy is a rare complication of aortic arch stenting not previously reported.     

Endovascular abdominal aortic stenosis treatment with the optimed self‐expandable nitinol stent

Purpose: To evaluate the safety and feasibility of self‐expandable stents (OptiMed) for treatment of abdominal aortic stenosis in the situations in which the aortic stenosis locates near the origin of celiac, superior mesenteric, renal and inferior mesenteric arteries. Methods: Five consecutive patients scheduled for endovascular treatment of abdominal aortic stenosis by self‐expandable nitinol stent (Sinus‐Aorta/OptiMed) implantation. The diameter of the stent was chosen as 10–30% more than that of the normal portion of the aorta above the stenosis. Long stents of 60 mm or longer were chosen. After stent deployment, balloon postdilation was performed with a balloon in patients with residual gradient > 5 mm Hg. Results: All patients were successfully treated with the OptiMed stents. The balloon predilation was performed in one patient due to severe stenosis. The mean diameter and length of the stents deployed were 20.4 ± 2.9 (range, 16–24 mm) and 64 ± 8.9 (range, 60–80 mm), respectively. The balloon postdilation was performed in all cases. The mean diameter of the balloons was 13.6 ± 1.5 (range, 12–15 mm). The mean diameter of stenosis increased from 4.8 ± 1.9 to 14.4 ± 1.8 mm after stent placement. The mean peak systolic gradient decreased from 46.8 ± 31.5 mm Hg to 0.8 ± 1.8 mm Hg. During follow‐up (22.8 ± 14.3 months), none of the patients had restenosis within the stent, occlusion of any branches of the aorta, or other related complications. Conclusions: In our small series, we observed that abdominal aortic stenosis can be successfully and effectively treated with OptiMed stents in the situations in which the stenotic segment is located next to the origins of the main visceral branches of abdominal aorta. © 2009 Wiley‐Liss, Inc.     

Endovascular stent implantation in patients with stenotic aortoarteriopathies: early and medium-term results.

Data regarding stent implantation for stenotic aortoarteriopathy (SAA) are incomplete. We report on nine patients with this rare syndrome who underwent arterial stent implantation. Indications, results, and complications for patients with SAA were reviewed. Nine patients underwent 11 procedures. Twenty-two stents were implanted in the aorta or brachiocephalic vessels. Five patients had diffuse stenoses, three patients had middle aortic syndrome, and one patient had thoracic and abdominal coarctation. Associated diagnoses included Williams syndrome (2), neurofibromatosis (2), Takayasu's (1), and congenital rubella (1). Median gradient was 60 mm Hg (20-140 mm Hg). Poststent gradient was 15 mm Hg (0-60 mm Hg; P < 0.001). Additional stents were implanted in two patients and five underwent stent redilation. Two patients (22%) were found to have aneurysm formation. Stent implantation effectively provides gradient relief in SAA. Gradient reduction persists or is amenable to redilation. Importantly, however, uncomplicated stent implantation does not preclude aneurysm formation and may be more common than in traditional patient groups.     

Pulmonary Artery Stent Implantation in Children with Single Ventricle Malformation Before and After Completion of Partial and Total Cavopulmonary Connections

Objectives: Relief of pulmonary artery stenosis before and after cavopulmonary connections (CPC) in patients with single ventricle malformation is essential to optimize pulmonary hemodynamics. We evaluated the risk factors for pulmonary artery stenosis and assessed the outcome after stent implantation .
Interventions: Seventeen stents in twelve patients were implanted for pulmonary artery stenosis before and after CPC at a mean age of 4.5 (0.1–17.6) years.
Results: Fourteen stents were placed in the left pulmonary artery (82%) and three stents in the right pulmonary artery (18%). One stent was implanted intraoperatively. Mean time between surgery and stent implantation was 28 (1–132) months. The mean (SD) size of the pulmonary artery stenosis was 3.1 ± 2.1 mm before and 8.1 ± 3.3 mm (P < 0.001) after stent implantation. Six out of seventeen stents (35.2%) had to be redilated after a mean time interval of 19 (5–48) months. Two patients' stents were removed during the next surgical procedure; both needed an early restenting of the affected vessel. There were no procedure-related complications for stent implantation or redilatation. Anatomical risk factors for pulmonary artery stenosis were right aortic arch and hypoplastic pulmonary arteries, whereas dilatation of the ascending aorta for LPA stenosis and Blalock–Taussig shunt for RPA stenosis were surgical risk factors.
Conclusions: Stent implantation to treat pulmonary artery stenosis in pediatric patients with CPC is effective and can be realized safely. Close follow-up is recommended in patients with risk for pulmonary artery stenosis. During total cavopulmonary connection, previously implanted stents at that site should be left in place or be changed in a hybrid procedure to a larger diameter, because the etiology of stenosis may persist after surgery and the surgical removal could result in vessel injury that promotes restenosis.     

Immediate and follow-up findings after stent treatment for severe coarctation of aorta

Experimental studies have shown that stents implanted at the aorta become incorporated within the aortic wall and can be further expanded in growing animals. Few clinical studies have shown that the stent repair of severe coarctation of aorta provides excellent initial results, and little is known on the follow-up of these patients. We assessed the immediate and follow-up results obtained in a series of 48 patients (mean age 14+/-12 years) with severe coarctation of the aorta who were treated by Palmaz stent implantation; 30 of them (63%) underwent angiographic follow-up studies at a mean of 25+/-11 months after treatment. Quantitative serial analysis of the aortogram (baseline, after treatment, and at follow-up) was performed. Significant relief (mean residual gradient 3+/-4 mm Hg) was always obtained after stent implantation. The isthmus, when hypoplastic (60%), was always expanded with the stent. One associated aneurysm became occluded after the implant. Complications included aortic disruption, stent migration, and decreased or absent femoral pulses. At angiographic follow-up, the stent remained always in place, without recoil. In 22 patients (73%), there were no detectable neointimal proliferation at late angiogram; however, 8 patients (27%) had some degree of intimal thickening (1 to 5 mm), causing mild restenosis in 3 patients treated at early age, and nonsignificant lumen reduction in 5. The serial aortogram analysis revealed a minor but significant increase in nonstented aortic diameters that seemed related to the normal growth of children. No need for stent reexpansion was observed at 2-year follow-up (mean). Two patients (7%) developed late small aneurysm formation at the stented wall; both were occluded by the insertion of coils through the stent orifices. We conclude that stent treatment for severe coarctation of aorta provides excellent immediate and long-term results in young adults and children. However, at early age, restenosis by intimal growth may develop.     

The obstructive subaortic conus

Eleven children are reported who had stenosis under a malposed aorta with gradients of 20 to 76 mm Hg between the right ventricle and aorta. The subaortic obstruction was caused by hypertrophy of the foreshortened infundibulum and malalignment of the infundibular septum relative to the remainder of the ventricular septum. Of these 11 patients, nine had a ventricular septal defect and seven had coarctation of the aorta. Rightward deviation of the infundibulum and aorta produced an unusually long left main coronary artery that was compressed by the stent of a bioprosthetic conduit valve in one patient. Serial cardiac catheterization studies in four patients showed progressive stenosis in each. Subaortic stenosis can develop in patients with malposition of the aorta and the frequency may be greater than 5% since milder forms are likely to occur. The obstruction can be progressive. The left coronary artery may be particularly vulnerable to compression after operative repair with an extracardiac conduit.     

Middle aortic syndrome treated by stent implantation

Objectives—To determine outcome of stent implantation in patients with middle aortic syndrome.
Design—Prospective study, case series.
Setting—A tertiary paediatric cardiology centre in a children's hospital.
Patients—Five patients, aged 4 to 17 years (mean 11.4 years), with upper limb hypertension due to middle aortic syndrome.
Intervention—Stents were implanted in the mid/lower thoracic/upper abdominal aorta.
Main outcome measure—Satisfactory deployment of stents and blood pressure control.
Results—In all patients, angiocardiography showed long segment stenosis in the mid or lower thoracic/upper abdominal aorta. The pressure gradient was between 40 and 90  mm Hg (mean 63.2  mm Hg). Seven Palmaz stents were implanted. Immediately after implantation, the gradient decreased to between 0 and 35  mm Hg (mean 13.6  mm Hg). Angiography showed a satisfactory result with widely patent stents in all. In one patient, thrombosis of the stent occurred six days after implantation. This was successfully treated with infusion of alteplase, further balloon dilatation, and implantation of a second stent overlapping the first, both dilated to 10 mm diameter. One patient had elective redilatation of the stent six months after implantation, with further reduction of the gradient from 35  mm Hg to 10  mm Hg. At the latest follow up between three and 20 months (mean 12.2 months) after stent implantation, in four patients blood pressure was better controlled with antihypertensive drugs. One patient was normotensive without drugs. Computed tomography showed no aneurysm formation in the region of the stents.
Conclusions—Stent implantation is a preferable alternative to surgery in the treatment of patients with middle aortic syndrome and merits further evaluation.

Keywords: middle aortic syndrome; stent implantation; paediatric cardiology; interventional cardiology     

Aortic valve balloon dilatation in infants with critical aortic stenosis

Twenty-six infants aged 10 days-11 months (mean 3.5 +/- 2.4 months), with critical aortic stenosis underwent aortic valve balloon dilatation in last six years. In 19 (73%) infants, aortic valve balloon dilatation had to be performed as an emergency procedure. The systolic gradients decreased from 71.7 +/- 11.8 mm Hg to 21.0 +/- 8.1 mm Hg. There was no procedural death. Severe aortic regurgitation developed in two (7.7%) which was medically managed. Four (15.4%) infants had femoral artery thrombosis following aortic valve balloon dilatation and all responded to intravenous streptokinase. Congestive heart failure resolved in all (100%). Two infants developed endocarditis during follow-up after aortic valve balloon dilation and one of them died, another patient died of severe pulmonary artery hypertension. In the surviving 24 infants, left ventricular function improved markedly. On follow-up of 18 +/- 5 months, restenosis developed in two (7.7%) patients. We conclude that aortic valve balloon dilatation is safe and effective treatment for infants with critical aortic stenosis and severe left ventricular dysfunction.     

Balloon dilation of postoperative right ventricular outflow obstructions

Balloon dilation was attempted in 16 patients, aged 5 months to 19.5 years, with right ventricular outflow obstruction after repair of congenital heart defects. Stenosis of a valved conduit between the pulmonary ventricle and pulmonary artery was present in nine patients with a mean transvalvular peak systolic ejection gradient of 61.6 +/- 21.0 mm Hg and a mean right ventricle to aorta pressure ratio of 0.9 +/- 0.2. Supravalvular pulmonary stenosis was present in seven patients; in five, stenosis was at the anastomotic site after the arterial switch operation with a mean peak systolic ejection gradient of 72.2 +/- 10.6 mm Hg and mean right ventricle to aorta pressure ratio of 0.93 +/- 0.05. The other two patients had stenosis at a previous pulmonary artery band site with a peak systolic ejection gradient of 60 and 65 mm Hg and right ventricle to aorta pressure ratio of 0.75 and 0.72, respectively. Balloon dilation was successful in three of nine patients with a valved conduit; two of them had additional successful balloon dilation of the right pulmonary artery. In five of the nine patients (including one with successful dilation) the conduit was replaced 5.7 +/- 4.5 months after balloon dilation. Balloon dilation was successful in only one of the five patients with supravalvular pulmonary stenosis after the arterial switch operation and partially successful in the two patients with supravalvular pulmonary stenosis at a previous band site. The success rate of balloon dilation of postoperative right ventricular outflow obstruction is much lower than that for other right heart obstructions.     

Hybrid stenting of aortic coarctation in very low birth weight premature infant

A very low birth weight infant with severe aortic coarctation developed progressive left ventricular dysfunction and pulmonary overflow with hemorrhage, while receiving prostaglandins. To avoid morbidity from conventional surgery or percutaneous intervention, a two‐step strategy was performed at a weight of 970 g. First vascular access was obtained through sternotomy: a 3/8 mm coronary stent was deployed through a 4 French sheath in the ascending aorta; the arterial duct was clipped. At the age of 5 months, the stent was removed and the aortic arch reconstructed with an end‐to‐end anastomosis through lateral thoracotomy. This strategy was not associated with morbidity typical for premature infants with congenital heart disease. © 2012 Wiley Periodicals, Inc.     

Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis: comparison with bare metal stent implantation

OBJECTIVES: This study was designed to compare the clinical and angiographic outcomes of sirolimus-eluting stent (SES) and bare metal stent (BMS) implantation for unprotected left main coronary artery (LMCA) stenosis. BACKGROUND: The safety and effectiveness of SES implantation for unprotected LMCA stenosis have not been ascertained. METHODS: Elective SES implantation for de novo unprotected LMCA stenosis was performed in 102 consecutive patients with preserved left ventricular function from March 2003 to March 2004. Data from this group were compared to those from 121 patients treated with BMS during the preceding two years. RESULTS: Compared to the BMS group, the SES group received more direct stenting, had fewer debulking atherectomies, had a greater number of stents, had more segments stented, and underwent more bifurcation stenting. The procedural success rate was 100% for both groups. There were no incidents of death, stent thrombosis, Q-wave myocardial infarction (MI), or emergent bypass surgery during hospitalization in either group. Despite less acute gain (2.06 +/- 0.56 mm vs. 2.73 +/- 0.73 mm, p < 0.001) in the SES group, SES patients showed a lower late lumen loss (0.05 +/- 0.57 mm vs. 1.27 +/- 0.90 mm, p < 0.001) and a lower six-month angiographic restenosis rate (7.0% vs. 30.3%, p < 0.001) versus the BMS group. At 12 months, the rate of freedom from death, MI, and target lesion revascularization was 98.0 +/- 1.4% in the SES group and 81.4 +/- 3.7% in the BMS group (p = 0.0003). CONCLUSIONS: Sirolimus-eluting stent implantation for unprotected LMCA stenosis appears safe with regard to acute and midterm complications and is more effective in preventing restenosis compared to BMS implantation.     

Treatment of severe valvular aortic stenosis and subvalvular discrete subaortic stenosis and septal hypertrophy with Percutaneous CoreValve Aortic Valve Implantation

Background : Percutaneous Aortic Valve Implantation (PAVI) is a procedure gaining popularity and becoming more widely used for the treatment of patients with severe aortic stenosis who are at high risk for surgery. Here we show, for the first time, that a successful and complete elimination of both valvular and subvalvular pressure gradients can be achieved with a slight modification of the valve implantation technique. Methods and Results : A 91‐year‐old woman presented with shortness of breath at rest, effort angina, and pulmonary congestion. Echocardiography revealed calcified aortic stenosis with a peak gradient of 75 mm Hg accros the valve, and discrete subaortic stenosis (DSS) and marked hypertrophy of the basal septum with systolic anterior motion of the mitral valve (SAM). The intra ventricular gradient had a dynamic pattern across the DSS and the septal hypertrophy and measured 75 mm Hg. The total gradient across the left ventricular outflow (valvular and subvalvular) was 125 mmHg. PAVI with a 23 mm CoreValve was performed with an intentional lower positioning of the valve towards the LV outflow tract; so that the valve struts cover the subaortic membrane and part of the thickened basal septum. At the end of the procedure, the SAM disappeared, and the left ventricular ouflow was widely open. At 1 month follow up the patient was asymptomatic, no pressure gradient was measured between the LV apex and the aorta. Conclusions : This is the first report of successful treatment of severe valvular aortic stenosis and combined subvalvular aortic stenosis due to DSS and septal hypertrophy with SAM with percutaneous aortic valve implantation. © 2010 Wiley‐Liss, Inc.     

Percutaneous left main coronary artery stent for acute myocardial ischemia after repaired ALCAPA

Percutaneous coronary artery stent angioplasty is rare in the pediatric population but can be a life‐saving by rapidly reestablishing flow to an obstructed coronary artery. It is a technically challenging and high‐risk procedure in infants and further limited by the need for future surgical intervention. We report of an infant with anomalous left coronary artery from the pulmonary artery who underwent acutely successful surgical reimplantation of the left coronary artery onto the ascending aorta. One month later, she developed acute myocardial ischemia and emergent catheterization diagnosed near‐total occlusion of the left coronary artery. We implanted a 2.5 mm coronary stent in the left main coronary artery with reestablishment of flow. The patient's left ventricular systolic function recovered within 4 weeks and repeat angiography 3 months later showed complete normalization of the entire left coronary artery system. The patient weighed 3 kg and was < 6 weeks of age at the time of stent implantation which to our knowledge is the smallest and youngest reported patient to undergo coronary stent angioplasty. This case supports the feasibility of this procedure in infants as a temporizing solution to hemodynamic instability from myocardial ischemia due to coronary artery stenosis. The left ventricular systolic function remained normal at 7 months after stent placement and the patient was clinically well from a cardiac perspective. © 2014 Wiley Periodicals, Inc.     

Surgical repair of the aortic coarctation combined with complete replacement of the ascending aorta and aortic arch

We present a 63-year-old patient with aortic valve stenosis, ascending aorta aneurysm, aortic coarctation as well as atherosclerotic, elongated, and stenosed aortic arch. Surgical treatment consisted of a complete ascending aorta replacement with a valved composite graft and complete replacement of the aortic arch including the isthmus, and was performed simultaneously through median sternotomy.     

Percutaneous treatment of aortic isthmus atresia

Background : Limited data exists in the literature concerning the percutaneous treatment of complete aortic isthmus atresia. Patients and Methods : Between January 2007 and November 2010, 40 subjects underwent percutaneous treatment of aortic coarctation in our catheterization laboratory. Four out of 40 had aortic isthmus atresia with complete interruption. Median age at procedure was 48 years (range, 32–63 years). All subjects had history of arterial systemic hypertension refractory to medical treatment. Two subjects had a previous history of haemorrhagic stroke. All procedures were performed under general anesthesia and orotracheal intubation. In each case radial and femoral artery access was obtained. A radiofrequency (RF) system (Baylis MedComp Inc, Montreal, Canada) consisting of a Nykanen 0.024'' RFguidewire and coaxial microcatheter were used to perforate and cross the atretic segment. A guidewire was then snared and an artero‐arterial circuitcreated. The area was predilated by using coronary angioplasty balloons. A 12 Fr Mullins long sheath was advanced and an E‐PTFE covered 8Zig Cheatham‐Platinum stent implanted. Patients were monitored in hospital for 48–72 hr. Follow‐up was performed at 1, 3, 6, 12 months, and yearly thereafter. Results : Percutaneous recanalization of the atretic segment was performed successfully in all subjects. Mean fluoroscopy and procedure times were 30 ± 6 and 90 ± 15 min, respectively. After implantation, the gradient decreased significantly (prestent: mean value 52.25 mm Hg [range 33–70 mm Hg] versus post stent: mean value 3 mm Hg [range, 0–10 mm Hg] [P < 0.0001]). The stents were placed in the correct position in all subjects and no immediate complications occurred. During a mean follow‐up of 19 months (2–41 months), there were nosignificant complication. All subjects had arterial systemic blood pressure within the normal range. In two out of four patients single agent antihypertensive drug therapy was needed. The first patient in our series was treated conservatively and needed further stent dilation with a second procedure approach, eight months after the initial stent implantation, performed without incident. Conclusions : Our data show that use of radiofrequency energy perforation and covered CP stent implantation is a safe, effective, and promising tool for treatment of complete aortic isthmus atresia. © 2011 Wiley Periodicals, Inc.     

Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up.

OBJECTIVES: The aim of this study was to evaluate the use of endovascular stents in native and recurrent coarctation of the aorta (CoA). BACKGROUND: Stents have been used successfully in various locations. Their use in CoA can be an alternative to surgery or balloon angioplasty (BA). METHODS: Thirty-four patients with CoA (13 native and 21 re-coarctation after surgery or BA) with a mean age of 16 +/- 8 years (range 4 to 36 years) underwent attempted stent implantation between 1993 and 1999. Successful outcome was defined as peak systolic pressure gradient after stent implantation < 20 mm Hg. RESULTS: Stents were implanted in 33/34 patients, and successful outcome occurred in 32/33 patients. Peak systolic pressure gradient decreased from 32 +/- 12 mm Hg to 4 +/- 11 mm Hg (p < 0.001). Coarctation site to descending aorta diameter ratio increased from 0.46 +/- 0.16 to 0.92 +/- 0.16 (p < 0.001). Two patients underwent successful stent re-dilation 16 and 21 months after initial implantation. Six patients (18%) developed complications, including two patients who underwent surgery. Follow-up for 29 +/- 17 months (range: 5 to 81 months) demonstrated no evidence of re-coarctation, aneurysm formation, stent displacement or fracture. Systolic blood pressure (SBP) decreased from 136 +/- 21 mm Hg before stent placement to 122 +/- 19 mm Hg at follow-up (p = 0.002). The SBP gradient decreased from 39 +/- 18 mm Hg to 4 +/- 6 mm Hg, and peak Doppler gradient decreased from 51 +/- 26 mm Hg to 13 +/- 11 mm Hg at follow-up (p < 0.001). CONCLUSIONS: Intravascular stent placement for native and recurrent CoA has excellent results in the short and intermediate terms. Long-term outcome remains to be evaluated.