Endovascular stent implantation in the pulmonary arteries of infants and children without the use of a long vascular sheath

Robert H. Pass, Daphne T. Hsu, Carl P. Garabedian, Myles S. Schiller, K. Anitha Jayakumar, William E. Hellenbrand

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Endovascular stent implantation for pulmonary artery stenosis requires the use of a long, large-bore vascular sheath to insure precise implantation without embolization or malposition. A long vascular sheath may be difficult to position and usage may be associated with vascular compromise and/or hemodynamic embarrassment, especially in infants and small children. We report a new technique for pulmonary artery endovascular stent implantation without the use of a long sheath. From December 2000 to May 2001, 10 patients underwent implantation of 13 Palmaz Corinthian premounted biliary transhepatic stents for pulmonary artery stenosis. Median age was 0.8 years (range, 0.5-18.5) and median weight was 11.8 kg (range, 4.6-65). Patient diagnoses were tetralogy of Fallot (five), double outlet right ventricle (three), branch peripheral pulmonary artery stenosis (two), single ventricle s/p cavopulmonary shunt (one), and truncus arteriosus (one). All Palmaz Corinthian stents were delivered uncovered on Cordis Opta LP balloon catheters via short sheaths (6-7 Fr); super-stiff guidewires were not always necessary. These stents, with a maximal expanded diameter of 12 mm, were placed for peripheral pulmonary artery stenosis as a definitive procedure or at the pulmonary artery bifurcation in patients who were expected to undergo future open heart surgery. The stents were initially implanted on 4, 6, or 8 mm balloon catheters and further expanded if needed. Stents were placed in the right pulmonary artery alone in three patients, left pulmonary artery alone in four patients, and side-by-side stents were implanted simultaneously in three patients. All thirteen stents were implanted successfully in the desired location without stent malposition or embolization. Mean angiographic diameter increased from 2.5 ± 1.5 to 5.7 ± 1.4 mm (P < 0.01) and peak systolic ejection gradients decreased from 44 ± 22 to 14 ± 11.6 mm Hg (P < 0.01). The uncovered delivery of the premounted Palmaz Corinthian stent allowed for precise and safe endovascular stent implantation without the hemodynamic and technical problems associated with long vascular sheath usage. This technique is useful for the palliation of proximal pulmonary artery stenosis and is effective definitive treatment for peripheral pulmonary artery stenosis in small infants and children.

Original languageEnglish (US)
Pages (from-to)505-509
Number of pages5
JournalCatheterization and Cardiovascular Interventions
Volume55
Issue number4
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Pulmonary Artery
Stents
Blood Vessels
Catheters
Hemodynamics
Right Heart Bypass
Truncus Arteriosus
Double Outlet Right Ventricle
Tetralogy of Fallot
Thoracic Surgery
Pulmonary Artery Stenosis
Weights and Measures

Keywords

  • Congenital catheterization
  • Heart defects

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Endovascular stent implantation in the pulmonary arteries of infants and children without the use of a long vascular sheath. / Pass, Robert H.; Hsu, Daphne T.; Garabedian, Carl P.; Schiller, Myles S.; Jayakumar, K. Anitha; Hellenbrand, William E.

In: Catheterization and Cardiovascular Interventions, Vol. 55, No. 4, 2002, p. 505-509.

Research output: Contribution to journalArticle

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AU - Hsu, Daphne T.

AU - Garabedian, Carl P.

AU - Schiller, Myles S.

AU - Jayakumar, K. Anitha

AU - Hellenbrand, William E.

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AB - Endovascular stent implantation for pulmonary artery stenosis requires the use of a long, large-bore vascular sheath to insure precise implantation without embolization or malposition. A long vascular sheath may be difficult to position and usage may be associated with vascular compromise and/or hemodynamic embarrassment, especially in infants and small children. We report a new technique for pulmonary artery endovascular stent implantation without the use of a long sheath. From December 2000 to May 2001, 10 patients underwent implantation of 13 Palmaz Corinthian premounted biliary transhepatic stents for pulmonary artery stenosis. Median age was 0.8 years (range, 0.5-18.5) and median weight was 11.8 kg (range, 4.6-65). Patient diagnoses were tetralogy of Fallot (five), double outlet right ventricle (three), branch peripheral pulmonary artery stenosis (two), single ventricle s/p cavopulmonary shunt (one), and truncus arteriosus (one). All Palmaz Corinthian stents were delivered uncovered on Cordis Opta LP balloon catheters via short sheaths (6-7 Fr); super-stiff guidewires were not always necessary. These stents, with a maximal expanded diameter of 12 mm, were placed for peripheral pulmonary artery stenosis as a definitive procedure or at the pulmonary artery bifurcation in patients who were expected to undergo future open heart surgery. The stents were initially implanted on 4, 6, or 8 mm balloon catheters and further expanded if needed. Stents were placed in the right pulmonary artery alone in three patients, left pulmonary artery alone in four patients, and side-by-side stents were implanted simultaneously in three patients. All thirteen stents were implanted successfully in the desired location without stent malposition or embolization. Mean angiographic diameter increased from 2.5 ± 1.5 to 5.7 ± 1.4 mm (P < 0.01) and peak systolic ejection gradients decreased from 44 ± 22 to 14 ± 11.6 mm Hg (P < 0.01). The uncovered delivery of the premounted Palmaz Corinthian stent allowed for precise and safe endovascular stent implantation without the hemodynamic and technical problems associated with long vascular sheath usage. This technique is useful for the palliation of proximal pulmonary artery stenosis and is effective definitive treatment for peripheral pulmonary artery stenosis in small infants and children.

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