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Intravascular stents in congenital heart disease: short- and long-term results from a large single-center experience.
Shaffer, K M; Mullins, C E; Grifka, R G; O'Laughlin, M P; McMahon, W; Ing, F F; Nihill, M R.
Afiliación
  • Shaffer KM; Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston 77030, USA.
J Am Coll Cardiol ; 31(3): 661-7, 1998 Mar 01.
Article en En | MEDLINE | ID: mdl-9502650
ABSTRACT

OBJECTIVES:

This report describes the results of the Food and Drug Administration's phase 1 and 2 clinical trials of intravascular stents at Texas Children's Hospital.

BACKGROUND:

Since the late 1980s, intravascular stent implantation for the treatment of arterial and venous stenoses in congenital heart disease has been highly successful.

METHODS:

Stents were placed in postoperative pulmonary artery (PA) stenoses, congenital PA stenoses or stenoses of systemic veins/venous anastomoses. Prospective collection of data according to protocol was done before intervention, after stent implantation and at follow-up catheterization.

RESULTS:

At stent implantation, pressure gradients decreased significantly in all three groups (mean +/- SD) from 46 +/- 25 to 10 +/- 13 mm Hg in postoperative PA stenoses (p < 0.001); from 71 +/- 45 to 15 +/- 21 mm Hg in congenital PA stenoses (p < 0.001); and from 7 +/- 6 to 1 +/- 2 mm Hg in stenoses of systemic veins/venous anastomoses stenoses (p < 0.001). Vessel diameters markedly increased from 6 +/- 3 to 12 +/- 3 mm in postoperative PA stenoses (p < 0.001); from 3 + 1 to 9 + 1 mm in congenital PA stenoses (p < 0.001); and from 3 +/- 4 to 12 +/- 4 mm in stenoses of systemic veins/venous anastomoses (p < 0.001). In the postoperative and congenital PA stenoses groups, right ventricular pressure decreased (right ventricular pressure indexed to femoral artery pressure ratio) from 0.63 +/- 0.2 to 0.41 +/- 0.02 (p < 0.001) and from 0.71 +/- 0.3 to 0.55 +/- 0.35 (p = 0.04), respectively. Perfusion to a single affected lung increased from 31 +/- 17% to 46 +/- 14% (p < 0.001). On recatheterization (mean 14 months), results varied minimally. Repeat angioplasty of residual stent stenoses was safe and effective. Complications included four early patients with stent migration, three with stent thrombosis and two deaths. There were no late complications. Significant restenosis occurred in only three patients.

CONCLUSIONS:

Intravascular stents for the treatment of vascular stenoses in congenital heart disease provide excellent immediate and long-term results.
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Arteria Pulmonar / Stents / Cardiopatías Congénitas Tipo de estudio: Etiology_studies / Guideline Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: J Am Coll Cardiol Año: 1998 Tipo del documento: Article País de afiliación: Estados Unidos
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Arteria Pulmonar / Stents / Cardiopatías Congénitas Tipo de estudio: Etiology_studies / Guideline Límite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Revista: J Am Coll Cardiol Año: 1998 Tipo del documento: Article País de afiliación: Estados Unidos