Stent Angioplasty for Critical Native Aortic Coarctation in Three Infants: Up to 15-Year Follow-Up Without Surgical Intervention and Review of the Literature.

Autor: Arfi AM; Section of Pediatric Cardiology, Department of Pediatric, King Faisal Specialist Hospital & Research center Gen. Org. Jeddah, Prince Saud Al-Faisal Street, Rowdah District, POB 40047, Jeddah, 21499, Kingdom of Saudi Arabia. maminarfi@gmail.com., Galal MO; Section of Pediatric Cardiology, Department of Pediatric, King Faisal Specialist Hospital & Research center Gen. Org. Jeddah, Prince Saud Al-Faisal Street, Rowdah District, POB 40047, Jeddah, 21499, Kingdom of Saudi Arabia.; Department of Pediatric Cardiology, Essen University, Essen, Germany., Kouatli A; Section of Pediatric Cardiology, Department of Pediatric, King Faisal Specialist Hospital & Research center Gen. Org. Jeddah, Prince Saud Al-Faisal Street, Rowdah District, POB 40047, Jeddah, 21499, Kingdom of Saudi Arabia., Baho H; Section of Pediatric Cardiology, Department of Pediatric, King Faisal Specialist Hospital & Research center Gen. Org. Jeddah, Prince Saud Al-Faisal Street, Rowdah District, POB 40047, Jeddah, 21499, Kingdom of Saudi Arabia.; Department of Pediatric Cardiology, Essen University, Essen, Germany.; Faculty of Medicine, Zagazig University, Ash Sharqiyah, Egypt., Abozeid H; Section of Pediatric Cardiology, Department of Pediatric, King Faisal Specialist Hospital & Research center Gen. Org. Jeddah, Prince Saud Al-Faisal Street, Rowdah District, POB 40047, Jeddah, 21499, Kingdom of Saudi Arabia.; Faculty of Medicine, Zagazig University, Ash Sharqiyah, Egypt., Al Ata J; Section of Pediatric Cardiology, Department of Pediatric, King Faisal Specialist Hospital & Research center Gen. Org. Jeddah, Prince Saud Al-Faisal Street, Rowdah District, POB 40047, Jeddah, 21499, Kingdom of Saudi Arabia.
Jazyk: angličtina
Zdroj: Pediatric cardiology [Pediatr Cardiol] 2018 Dec; Vol. 39 (8), pp. 1501-1513. Date of Electronic Publication: 2018 Jun 12.
DOI: 10.1007/s00246-018-1922-8
Abstrakt: Management of neonatal native coarctation is debated till now. Surgical therapy remains an option but may be unwarranted in critically sick infants with complex lesions. Balloon dilatation has been employed but with early re-stenosis. Stent angioplasty has also been used but as a bridge towards definitive surgical therapy. Four critically sick infants with complex coarctation and additional co-morbidity factors underwent primary stent therapy as surgical intervention was denied. One patient had died earlier due to reasons unrelated to the procedure. Three survivors underwent multiple dilatations of primary stents as indicated. One of the three survivors did not require any further dilatation after the age of 5 years and remained stable till the time of reporting. High-pressure Cheatham Platinum stents were implanted inside the primary stents in two infants, who developed re-stenosis due to somatic growth. These stents were further balloon dilated at high atmospheric pressure. Femoral arteries in both of them were blocked but were re-canalized after balloon dilatation in one and stent angioplasty in the other. After a follow-up of about 15 years, all of them have been doing fine with acceptable Doppler gradients. They were normotensive and on no cardiac medications. It can be concluded that, though surgical repair remains a standard of care, stent angioplasty in selected infants with complex lesions is feasible and effective. Multiple dilatations can be performed without added risk of stent migration. Bio-absorbable and growth stents hold a promise for future use in such situations.
Databáze: MEDLINE
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