Emergency balloon dilation or stenting of critical coarctation of aorta in newborns and infants: An effective interim palliation

Abstract

Background:Management of native uncomplicated coarctation in neonates remains controversial with current evidence favoring surgery. The logistics of organizing surgical repair at short notice in sick infants with critical coarctation can be challenging.Methods and Results:We reviewed data of 10 infants (mean age of 2.9 ±1.6 weeks) who underwent catheter intervention for severe coarctation and left ventricular (LV) dysfunction between July 2003 and August 2007. Additional cardiac lesions were present in 7. Mean systolic gradient declined from 51±12 mm Hg to 8.7±6.7 mm Hg after dilation. The coarctation segment was stented in five patients. Procedural success was achieved in all patients with no mortality. Complications included brief cardiopulmonary arrest (n =1), sepsis (n = 1) and temporary pulse loss (n = 2). LV dysfunction improved in all patients. Average ICU stay was 5±3.4 days and hospital stay was 6.5±3.4 days. On follow-up (14.1±10.5 months), all developed restenosis after median period of 12 weeks (range four to 28 weeks). Three (two with stents) underwent elective coarctation repair, two underwent ventricular septal defect (VSD) closure and coarctation repair and one underwent pulmonary artery (PA) banding. Two patients who developed restenosis on follow-up were advised surgery, but did not report. Two (one with stent) underwent redilatation and are being followed with no significant residual gradients.Conclusion:Balloon dilation ± stenting is an effective interim palliation for infants and newborns with critical coarctation and LV dysfunction. Restenosis is inevitable and requires to be addressed.

The use of small stents to delay surgical intervention in very young children with critical congenital heart disease

“…Reported success rate ranges between 80% -100%. (5,6,(10)(11)(12)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) Our findings compare favourably with this. Overall, low periprocedural complication rates have been reported in stents used in older children (up to 16%).…”

“…However, as the group of patients is quite diverse, it is difficult to compare the overall mortality to a similar surgical series. (3)(4)(5)(6)(10)(11)(12)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) Mortality in surgical COA repairs in infants for example, is known to be much lower (<2%), but higher in small, complex patients (5 -25%). (3,12) It should be mentioned that one patient was sent home for palliative care and one patient had severe post-operative hypoxia and acidosis.…”

“…(14) Experience in stenting very young and small patients with critical obstructive congenital heart disease is limited and consists mostly of case reports and a few review articles. (5,6,(10)(11)(12)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) The majority reported good immediate results, but limited data on follow-up and final outcomes is available.…”

Transcatheter Stent Therapy in Children: An Update

“…In the older child, adolescent and adult, primary stent therapy is advised both for native aortic coarctation and post-surgical recoarctation. Because of issues related to growth and the need for large sheaths for implantation, most cardiologists limit stent usage to adolescents and adults, although some workers [15,105,[111][112][113][114] advocate stents in infants and young children. We do not advocate routine use of stents in neonates, infants and young children [106,115].…”

Percutaneous Balloon Angioplasty for Aortic Coarctation in Newborns and Infants: Is It Still an Option?

“…In these cases, probably percutaneous balloon angioplasty is an effective and temporary alternative to surgery in order to minimize the operative risk and prepare them for safer final management [8,14]. Other authors have proven the efficacy and safety of this treatment option in this category of infants [8,14,23]. Interestingly 35% of our patients did not require further surgical management.…”