Sullivan Patrick M, Liou Aimee, Takao Cheryl, Justino Henri, Petit Christopher J, Salazar Jorge D, Ing Frank F
Division of Pediatric Cardiology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California.
Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Catheter Cardiovasc Interv. 2017 Nov 15;90(6):963-971. doi: 10.1002/ccd.27234. Epub 2017 Sep 1.
Unique and small anatomical features often preclude the use of available vascular stents in pediatric patients with congenital heart disease (CHD).
To report our experience and outcomes tailoring stents to fit unique anatomy, particularly in small children and infants with CHD.
Stent tailoring techniques included trimming, folding, and flaring. Patients receiving a tailored stent November 2002 to February 2015 were included in a retrospective analysis.
Forty-one tailored stents were implanted in 30 patients with median age and weight of 0.8 years (6 days to 17 years) and 8.1 kg (2.9-47.9 kg). Thirty stents were placed intraoperatively and 11 percutaneously. Sites included branch pulmonary arteries (BPA; n = 32), pulmonary veins (n = 6), SVC (n = 1), and the ventricular septum (n = 2). Twenty-three (56%) stents were trimmed with or without folding to avoid jailing of side branches, 16 (39%) stents were folded or flared with or without trimming to avoid excessive proximal protrusion, and two (5%) stents were folded back at both ends for implantation in ventricular septal defects. Final stent lengths were 6-15 mm. Minimal vessel diameters increased from 2.8 ± 1.4 mm to 6.7 ± 2.6 mm (P < 0.001). Complications included two intraoperative BPA tears, three pinhole balloon leaks, two intraoperative stent dislodgements, one transient heart block, and one lung reperfusion injury. Follow-up catheterization included 36 re-dilations and implantation of four additional stents over a median of 4.1 years. In-stent restenosis was the indication in 25 (69.4%) re-interventions.
Tailored stents can be safely implanted to fit unique anatomy in small patients. Re-interventions can effectively treat restenosis and accommodate ongoing vessel growth.
独特且微小的解剖特征常常使现有的血管支架无法应用于患有先天性心脏病（CHD）的儿科患者。
报告我们根据独特解剖结构定制支架的经验及结果，尤其是针对患有CHD的幼儿和婴儿。
支架定制技术包括修剪、折叠和扩口。对2002年11月至2015年2月期间接受定制支架的患者进行回顾性分析。
30例患者共植入41个定制支架，年龄中位数为0.8岁（6天至17岁），体重中位数为8.1 kg（2.9 - 47.9 kg）。30个支架在术中置入，11个经皮置入。置入部位包括分支肺动脉（BPA；n = 32）、肺静脉（n = 6）、上腔静脉（n = 1）和室间隔（n = 2）。23个（56%）支架进行了修剪，有的还进行了折叠，以避免分支血管被封堵；16个（39%）支架进行了折叠或扩口，有的还进行了修剪，以避免近端过度突出；2个（5%）支架两端折叠后用于室间隔缺损的植入。最终支架长度为6 - 15 mm。最小血管直径从2.8 ± 1.4 mm增加到6.7 ± 2.6 mm（P < 0.001）。并发症包括2例术中BPA撕裂、3例针孔状球囊泄漏、2例术中支架移位、1例短暂性心脏传导阻滞和1例肺再灌注损伤。随访导管检查包括36次再次扩张，在中位时间4.1年期间又植入了4个支架。25次（69.4%）再次干预的指征为支架内再狭窄。
定制支架能够安全地植入，以适应小患者独特的解剖结构。再次干预能够有效治疗再狭窄并适应血管的持续生长。
