Right ventricular outflow tract and pulmonary artery stents in children under 18 months of age

Abstract

To report our experience on patients less than 18 months of age in whom stents were placed either in the right ventricular outflow tract (RVOT) or pulmonary arteries. Although percutaneous placement of intravascular stents in congenital heart disease is common practice, there are few reports regarding placement in young children. Retrospective review of our database identified 19 patients less than 18 months of age who underwent placement of 26 stents in either the RVOT or pulmonary arteries. Data evaluated were patient age, gender, weight, site of narrowing, type of stent, gradient across the area of narrowing pre- and post-stent placement, vessel size pre- and post-stent placement, gradient, and vessel size on followup, and ability to redilate the stent if necessary. Mean patient age was 9.7 months (range 0.5-17.5 months). There were 14 males and 5 females with a mean weight of 7.1 kg (range 2.3-10.2 kg). Five patients had stents placed in the RVOT and 14 patients had 21 stents placed in the branch pulmonary arteries. Two Johnson and Johnson P188 stents were used, 23 premounted Genesis biliary stents and 1 other. Gradient across the stenotic area decreased from a mean of 52.9 mm Hg (range 20-80 mm Hg) to 15 mm Hg (range 3-40 mm Hg) (P<.001). Percutaneous placement of intravascular stents in young children is a viable procedure, can provide excellent relief of stenoses, and increases vessel size in the short term. Although many of these stents cannot be dilated to adult size, their efficacy in small infants and children in whom further surgery will ultimately be required makes them desirable for this group of patients.