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CLINICAL STUDIES

Early and intermediate-term complications of self-expanding stents limit its potential application in children with congenital heart disease

Yiu-fai Cheung, MBBS^*, Shubhayan Sanatani, BSc, MD, Maurice P. Leung, MD, FACC^*, Derek G. Human, MA, BM, BCL, Adolphus K. T. Chau, MBBS^* and J. A. Gordan Culham, MD

^* Division of Pediatric Cardiology, Grantham Hospital, Department of Pediatrics, University of Hong Kong, Aberdeen, Hong Kong
Division of Pediatric Cardiology, British Columbia Children’s Hospital, Vancouver, Canada

Manuscript received November 25, 1998; revised manuscript received October 20, 1999, accepted December 2, 1999.

Reprint requests and correspondence: Dr. Maurice P. Leung, Division of Pediatric Cardiology, Grantham Hospital, University of Hong Kong, 125 Wong Chuk Hang Road, Aberdeen, Hong Kong
mpleung{at}hkucc.hku.hk

OBJECTIVES

We report on the early and intermediate-term follow-up results of self-expanding Wallstent (Schneider, Switzerland) implanted in children with congenital heart disease.

BACKGROUND

The inherent shortcomings of balloon-expandable stents prompted the trial of an alternative stent.

METHODS

Twenty patients underwent 22 implantations of 25 self-expanding Wallstents between December 1993 and June 1997 in two institutions. The mean age and weight were 10.8 ± 4.5 years and 30.5 ± 14.2 kg, respectively. The patients were divided into two groups: 1) Group I comprised 17 patients with pulmonary arterial stenoses, 2) Group II comprised four patients with venous stenoses (one belonged to both groups). Sixteen patients underwent recatheterization at a median of 5.8 months (range 0.5 to 31, mean 8.1 months) after stenting. Hemodynamic and angiographic changes after the interventional procedures and complications were documented.

RESULTS

All the stents were successfully deployed in the intended position. In Group I, the narrowest diameter of the stented vessel increased from 4.1 ± 1.5 to 8 ± 2 mm (95% increase, p < 0.0001) while the systolic pressure gradient across decreased from 24.6 ± 15.8 to 12.1 ± 11.4 mm Hg (51% decrease, p = 0.001). In Group II, the dimensional changes of the narrowest segment increased from 4.3 ± 0.5 to 7.5 ± 0.4 mm (75% increase, p = 0.003), and the pressure gradient reduced from 5.0 ± 2.9 to 0.9 ± 1.0 mm Hg (82% decrease, p = 0.04) across the stented venous channel. Distal migration of two optimally positioned stents occurred within 24 h of implantation. At recatheterization, significant neointimal ingrowth (>30% of the expanded diameter) was noted in 7 (28%) of the 25 implanted stents. This responded poorly to balloon dilation. Predisposing factors for the neointimal ingrowth included stents of smaller diameter (<9 mm) and longer period after implantation.

CONCLUSIONS

Self-expanding Wallstent could be deployed easily and safely to relieve vascular stenoses in children. The complications of distal migration, significant neointimal ingrowth and its unyielding design to overdilation limit its application to this patient group.

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