Cheatham-Platinum Stent Implantation for Pulmonary Artery Stenosis in Children and Adolescents: Immediate and Mid-term Outcome

Overview

Journal World J Pediatr

Specialty Pediatrics

Date 2010 Nov 17

PMID 21080145

Authors

Wu Zhao

Fen Li

Ai-qing Zhou

Wei Gao

Zhi-Qing Yu

Kun Sun

Mei-Rong Huang

Yun Li

Jian-Ping Yang

Affiliations

Soon will be listed here.

Abstract

Background: NuMED Cheatham-Platinum (CP) stent implantation for pulmonary artery stenosis in children and adolescents has been rarely reported. This study aimed to evaluate the immediate and mid-term results of CP stent implantation for the treatment of pulmonary artery stenosis associated with congenital heart disease (CHD) in children and adolescents.

Methods: From August 2005 to May 2007, four consecutive pediatric patients with pulmonary artery stenosis associated with CHD underwent CP stent implantation. They were followed up, and transthoracic echocardiography was done for outcome evaluation.

Results: In the four patients, 5 stent placement procedures were performed and 7 CP stents were implanted (8-zig, 22-39 mm in length). All stents except one were successfully placed in the target lesions without displacement during the procedures. After the procedure, the systolic pressure gradient across the stenosis decreased from 36.67 ± 20.08 to 3.67 ± 3.20 mmHg (P=0.005), and the narrowest diameter of the stenotic segment increased from 6.97 ± 2.22 to 13.40 ± 4.40 mm (P=0.013). Two stents implanted in the left and right pulmonary arteries in patient 4 developed intrastent restenosis 6 months after the procedure, and the distal end of the main pulmonary artery also developed restenosis 26 months later. The results of the remaining stents have been stable without complications during a median follow-up of 34 months (range, 26-48 months).

Conclusions: Our experience indicates that CP stent implantation is suitable for the treatment of pulmonary artery stenosis in children and adolescents with CHD. The immediate and mid-term results are encouraging, but long-term results demand further follow-up in more cases.

References

OLaughlin M, Perry S, Lock J, Mullins C . Use of endovascular stents in congenital heart disease. Circulation. 1991; 83(6):1923-39. DOI: 10.1161/01.cir.83.6.1923. View

Bacha E, Kreutzer J . Comprehensive management of branch pulmonary artery stenosis. J Interv Cardiol. 2002; 14(3):367-75. DOI: 10.1111/j.1540-8183.2001.tb00346.x. View

Lock J, Fuhrman B, Bass J . Balloon dilation angioplasty of hypoplastic and stenotic pulmonary arteries. Circulation. 1983; 67(5):962-7. DOI: 10.1161/01.cir.67.5.962. View

Hwang B, Lee P, Fu Y, Jan S, Kao C, Wang P . Transcatheter implantation of intravascular stents for postoperative residual stenosis of peripheral pulmonary artery stenosis. Angiology. 2004; 55(5):493-8. DOI: 10.1177/000331970405500504. View

Trivedi K, Benson L . Interventional strategies in the management of peripheral pulmonary artery stenosis. J Interv Cardiol. 2003; 16(2):171-88. DOI: 10.1046/j.1540-8183.2003.08031.x. View

Formigari R, Santoro G, Guccione P, Giamberti A, Pasquini L, Grigioni M . Treatment of pulmonary artery stenosis after arterial switch operation: stent implantation vs. balloon angioplasty. Catheter Cardiovasc Interv. 2000; 50(2):207-11. DOI: 10.1002/(sici)1522-726x(200006)50:2<207::aid-ccd14>3.0.co;2-u. View

Zeevi B, Berant M, Blieden L . Midterm clinical impact versus procedural success of balloon angioplasty for pulmonary artery stenosis. Pediatr Cardiol. 1997; 18(2):101-6. DOI: 10.1007/s002469900125. View

Pass R, Hsu D, Garabedian C, Schiller M, Jayakumar K, Hellenbrand W . Endovascular stent implantation in the pulmonary arteries of infants and children without the use of a long vascular sheath. Catheter Cardiovasc Interv. 2002; 55(4):505-9. DOI: 10.1002/ccd.10160. View

Cheatham J . Stenting of coarctation of the aorta. Catheter Cardiovasc Interv. 2001; 54(1):112-25. DOI: 10.1002/ccd.1249. View

10.

Ewert P, Schubert S, Peters B, Abdul-Khaliq H, Nagdyman N, Lange P . The CP stent--short, long, covered--for the treatment of aortic coarctation, stenosis of pulmonary arteries and caval veins, and Fontan anastomosis in children and adults: an evaluation of 60 stents in 53 patients. Heart. 2005; 91(7):948-53. PMC: 1768992. DOI: 10.1136/hrt.2004.040071. View

11.

Haas N, Lewin M, Knirsch W, Nossal R, Ocker V, Uhlemann F . Initial experience using the NuMED Cheatham Platinum (CP) stent for interventional treatment of coarctation of the aorta in children and adolescents. Z Kardiol. 2005; 94(2):113-20. DOI: 10.1007/s00392-005-0180-y. View

12.

McMahon C, El-Said H, Grifka R, Fraley J, Nihill M, Mullins C . Redilation of endovascular stents in congenital heart disease: factors implicated in the development of restenosis and neointimal proliferation. J Am Coll Cardiol. 2001; 38(2):521-6. DOI: 10.1016/s0735-1097(01)01406-1. View

13.

Hosking M, Thomaidis C, Hamilton R, Burrows P, Freedom R, Benson L . Clinical impact of balloon angioplasty for branch pulmonary arterial stenosis. Am J Cardiol. 1992; 69(17):1467-70. DOI: 10.1016/0002-9149(92)90902-b. View

14.

Mitropoulos F, Laks H, Kapadia N, Gurvitz M, Levi D, Williams R . Intraoperative pulmonary artery stenting: an alternative technique for the management of pulmonary artery stenosis. Ann Thorac Surg. 2007; 84(4):1338-41. DOI: 10.1016/j.athoracsur.2007.04.121. View

15.

McMahon C, El Said H, Vincent J, Grifka R, Nihill M, Ing F . Refinements in the implantation of pulmonary arterial stents: impact on morbidity and mortality of the procedure over the last two decades. Cardiol Young. 2005; 12(5):445-52. DOI: 10.1017/s1047951102000768. View

16.

Duke C, Rosenthal E, Qureshi S . The efficacy and safety of stent redilatation in congenital heart disease. Heart. 2003; 89(8):905-12. PMC: 1767765. DOI: 10.1136/heart.89.8.905. View

17.

Trant Jr C, OLaughlin M, Ungerleider R, Garson Jr A . Cost-effectiveness analysis of stents, balloon angioplasty, and surgery for the treatment of branch pulmonary artery stenosis. Pediatr Cardiol. 1997; 18(5):339-44. DOI: 10.1007/s002469900195. View

18.

Nakanishi T . Balloon dilatation and stent implantation for vascular stenosis. Pediatr Int. 2001; 43(5):548-52. DOI: 10.1046/j.1442-200x.2001.01462.x. View