Unusual Stents in Infants with Severe Congenital Heart Disease

Abstract

Two infants with severe congenital heart disease requiring intervention are described. Although both required conventional surgical therapy, mitigating circumstances led to catheter intervention for short-term palliation. The feasibility and advisability of such procedures is discussed.

Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot

“…Palliative stenting of the native right ventricular outflow to address muscular obstruction has been described in case reports in the settings of pulmonary atresia with intact ventricular septum, pulmonary stenosis with RV hypertrophic cardiomyopathy and tetralogy of Fallot in a 970 g infant 25 – 27. Stent positioning is critical and even with dramatic improvement in oxygen saturation with the first implant, additional stents may be required to span the entire distance from the infundibular obstruction across the pulmonary valve.…”

Palliative stent placement in vertical vein in a 1.4 kg infant with obstructed supracardiac total anomalous pulmonary venous connection

“…A few previous cases have reported transcatheter interventional procedures as alternative therapeutic options for relief of pulmonary venous obstruction and to stabilize the clinical status before surgery. Balloon angioplasty was used in the initial era and stent placement has been recently reported in more cases .…”

“…We performed a review of literature on palliative transcatheter interventional procedures for obstructed TAPVC . A total of 17 cases including ours were reported (Table ) and can be categorized into two groups: (1) obstructed TAPVC with other complex cardiac anatomy including AVSD, n= 6; (2) obstructed TAPVC with no other cardiac anomalies except PDA and secundum atrial septal defect, n = 11.…”

“…Balloon angioplasty and stent placement in obstructed TAPVC have been previously reported in a few scattered cases . We report a successful palliative stent placement in obstructed supracardiac TAPVC in a very low birth weight (1.4 kg) infant.…”

Primary Palliative Stenting against Obstructive Mixed‐Type Total Anomalous Pulmonary Venous Connection Associated with Right Atrial Isomerism

“…There are some reports of short‐term stent implantation for obstructive supracardiac TAPVC in neonates or young infants in critical condition such as dependent extracorporeal membrane oxygenation, 7 cardiopulmonary shock, 8,9 suspected necrotizing enterocolitis, 10 and respiratory syncytial virus infection 11 . There is also a report of mid‐term palliative stenting for obstructive infracardiac TAPVC associated with RAI, resulting in successful TAPVC repair at 6 months of age 12 .…”