Tailoring stents to fit the anatomy of unique vascular stenoses in congenital heart disease

• Published in: Catheterization and cardiovascular interventions 2017-11, Vol.90 (6), p.963-971
• Main Authors: Sullivan, Patrick M., Liou, Aimee, Takao, Cheryl, Justino, Henri, Petit, Christopher J., Salazar, Jorge D., Ing, Frank F.
• Format: Article
• Language: English
• Subjects: Abnormalities, Multiple - diagnosis; Abnormalities, Multiple - surgery; Adolescent; Anatomy; Balloon treatment; Blood Vessels - diagnostic imaging; Cardiovascular disease; Catheterization; Child; Child, Preschool; Children; Complications; Congenital diseases; congenital heart disease; Constriction, Pathologic; Coronary artery disease; Endovascular Procedures - methods; Female; Folding; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - surgery; Heart diseases; Humans; Implantation; Implants; Infant; Infant, Newborn; Infants; intravascular stent therapy; Lungs; Male; Prosthesis Design; Prosthesis Implantation - methods; Pulmonary arteries; Pulmonary artery; Reperfusion; Restenosis; Retrospective Studies; Septum; stent modifications, pediatrics; Stents; Ventricle
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.27234

Background Unique and small anatomical features often preclude the use of available vascular stents in pediatric patients with congenital heart disease (CHD). Objectives To report our experience and outcomes tailoring stents to fit unique anatomy, particularly in small children and infants with CHD. Methods Stent tailoring techniques included trimming, folding, and flaring. Patients receiving a tailored stent November 2002 to February 2015 were included in a retrospective analysis. Results Forty‐one tailored stents were implanted in 30 patients with median age and weight of 0.8 years (6 days to 17 years) and 8.1 kg (2.9–47.9 kg). Thirty stents were placed intraoperatively and 11 percutaneously. Sites included branch pulmonary arteries (BPA; n = 32), pulmonary veins (n = 6), SVC (n = 1), and the ventricular septum (n = 2). Twenty‐three (56%) stents were trimmed with or without folding to avoid jailing of side branches, 16 (39%) stents were folded or flared with or without trimming to avoid excessive proximal protrusion, and two (5%) stents were folded back at both ends for implantation in ventricular septal defects. Final stent lengths were 6–15 mm. Minimal vessel diameters increased from 2.8 ± 1.4 mm to 6.7 ± 2.6 mm (P