Intravascular ultrasound use for stent optimization during percutaneous coronary intervention in a toddler with post-surgical stenosis after coronary reimplantation for ALCAPA

Abstract

Percutaneous coronary intervention (PCI) is an uncommon procedure in the pediatric population, and the use of intravascular ultrasound (IVUS) to guide stent optimization in this setting is not well described. We present a case of a 22-month old female who developed left main coronary stenosis following surgical correction of anomalous left coronary artery from the pulmonary artery (ALCAPA). PCI was pursued, and with the use of IVUS, stent placement was determined to be optimal. Given the limited data on the use of IVUS in PCI for children, we discuss the unique applications of IVUS, drug-eluting stents, and future clinical concerns following management of post-surgical stenosis following ALCAPA repair. hLearning objective: Percutaneous coronary intervention is a rare procedure in the pediatric population, and the use of intravascular ultrasound to optimize stent placement is not well described in this setting. Intravascular ultrasound may allow for more precise stent placement and may be useful during acute and long-term management of pediatric patients undergoing percutaneous coronary intervention.i

Intravascular ultrasound-guided stent implantation in reimplanted left main coronary artery of a 15-year-old child: a case report

“… 10 , 11 However, only a few reports have so far described the application of IVUS-guided PCI to treat stenosis of a reimplanted LMCA in patients with ALCAPA without any long-term follow-up. 7 In the present case, optimal angiography and IVUS results were obtained, and the patient developed no significant symptoms and had relatively normal cardiac function. This outcome confirms the feasibility of IVUS-guided PCI in such patients.…”

“… 4 , 5 Restenosis of a reimplanted LMCA is rare, with only a few cases reported so far. 6 , 7 The pathophysiological mechanism is ambiguous but may involve the long distance between anatomical structures, excessive extension or even distortion of the LCA, increased tissue stiffness, and metabolic disorders. 8 In fact, it has been hypothesized that the tractive force exerted on the LMCA after reimplantation and vascular rupture during an operation play the key role.…”