Stents in the Management of Aortic Coarctation in Young Children

A novel braided biodegradable stent for use in congenital heart disease: Short-term results in porcine iliac artery

To evaluate the properties and efficacy of a novel braided biodegradable stent (BBS) consisting of poly (p-dioxanone) (PPDO) and polycaprolactone (PCL) for usage in children with congenital cardiovascular diseases. PCL/PPDO composite filaments were fabricated by coating PCL layers onto PPDO filaments, which were fused with PPDO monofilaments to form the BBS. Physical properties of BBSs including elastic recovery rate, deformation rate, and mechanical characteristics with adjunctive post-dilation were evaluated by radial force-tests. Ten BBS stents and 10 metallic wall stents (WS) as controls were implanted into the common carotid arteries of 10 pigs and angiography as well as histological examinations were performed 4 and 8 weeks after implantation. An 8 mm BBS with adjunctive post-dilation had the best morphological retention and dimension stability being similar to an 8 mm WS. Luminal gain percentages of BBS and WS immediately, 4 weeks and 8 weeks after implantation were 20.44 ± 2.82% and 27.08 ± 0.88%, 12.34 ± 0.18% and 17.32 ± 8.24%, as well as -1.76 ± 2.45% and - 0.98 ± 3.23%. Luminal areas, internal elastic laminas, neointimal areas, neointimal thicknesses, and area stenosis were not significantly different at 4 weeks and 8 weeks after implantation. Injury and inflammation were similar in both groups and no malposition, thrombosis or dissection occurred. BBS with adjunctive post-dilation showed good physical properties and mechanical stability noninferior to WS. In vivo evaluations showed that a BBS with post-ballooning had similar short-term outcomes as a WS. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1667-1677, 2019.

Management of Congenital Heart Disease: State of the Art; Part I-ACYANOTIC Heart Defects

Since the description of surgery for patent ductus arteriosus in late 1930s, an innumerable number of advances have taken place in the management of congenital heart defects (CHDs). In this review the current status of treatment of seven of the most common acyanotic CHDs was reviewed. The discussion included indications for, and timing of, intervention and methods of intervention. The indications are, by and large, determined by the severity of the lesion. Pressure gradients in obstructive lesions and the magnitude of the shunt in left-to-right shunt lesions are used to assess the severity of the lesion. The timing of intervention is different for each lesion and largely dependent upon when the criteria for indications for intervention were met. Appropriate medical management is necessary in most patients. Trans-catheter methods are preferable in some defects while surgery is a better option in some other defects. The currently available medical, trans-catheter, and surgical methods to treat acyanotic CHD are feasible, safe, and effective.

The Journey of an Indian Pediatric Cardiologist : Dr. K. C. Chaudhuri Lifetime Achievement Award/Oration at AIIMS, New Delhi, September 2017

The life journey of an Indian pediatric cardiologist, who bestowed considerable attention to the development of new knowledge and train/teach physicians around the world while providing care of patients with heart disease over a 45-y period, is reviewed. This appraisal focuses particular attention on the scientific contributions to the literature. These include spontaneous closure of physiologically advantageous ventricular septal defects, various issues related to a congenital heart defect namely, tricuspid atresia and transcatheter and, interventional pediatric cardiac procedures.

Cheatham platinum stent implantation in children with coarctation of the aorta: single-centre short-term, intermediate-term, and long-term results from Turkey

OBJECTIVES

Our aim was to evaluate patients who were treated by percutaneous stent implantation.

METHODS

Patients with aortic coarctation (n = 35) who had been treated with 38 stents - 12 bare and 26 covered - were evaluated. The demographics and procedural and follow-up data were recorded from hospital registers and compared according to patient specifications, for example, weight and coarctation nature.

RESULTS

The procedure was successful in all patients. There was a statistically significant difference between the patients with native coarctation (n = 17) and those with recurrent coarctation (n = 18) in terms of pre-procedural blood pressures, systolic gradients, coarctation diameters, and the ratio of the coarctation site diameter to the descending aorta diameter. Although all patients received antihypertensive drugs before the procedure, the drug was discontinued in 26 patients during follow-up (p < 0.001). Stent migration was observed in four patients with recurrent coarctation (11.4%), and peripheral arterial injury was seen in three patients (8.5%). The mean follow-up time was 34 ± 16 months. On average, 21 (6-42) months after the procedure, six patients underwent cardiac catheterisation. At least 2 years after the procedure, tomography was performed in 20 patients (57.2%). Patients who were evaluated by multi-slice computerised tomography revealed no pathologies. There was no statistically significant difference between the five patients weighing less than 20 kg and the other 30 patients in terms of demographic and procedural characteristics, procedure success and complication rates, and follow-up data.

CONCLUSION

Stent implantation for aortic coarctation is a method yielding satisfactory results in reducing coarctation gradients, efficient enlargement of the lesion area, and resolution of hypertension for children, including those weighing less than 20 kg.

[Interventional cardiac catheterization in children]

With the technological progress, the role of the cardiac catheterization has dramatically changed, moving from diagnostic to therapeutic and becoming adjuvant to surgical procedures. In various congenital heart defects, it allows to postpone the need for surgery or even cancel the surgical indication being less invasive and as powerful as surgery. It is thanks to many technological advances, in particular with the development of devices with memory alloy, that the catheterization makes such great strides today, and the miniaturization of the prosthetic material makes it possible to push back more and more the limits of feasibility which remain related to the smallness of the vascular accesses at the newborn age. The future of this discipline lies in the hybrid procedures, where a true teamwork between the surgeons and the pediatric cardiologists makes it possible to bring the best therapeutic strategy for patients with congenital heart defects.