Chaszczewski Kasey J, Nicholson George T, Shahanavaz Shabana, Dori Yoav, Gillespie Matthew J, O'Byrne Michael L, Rome Jonathan J, Glatz Andrew C
5506Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
Section of Pediatric Cardiology, The Herma Heart Institute, Milwaukee, WI, USA.
World J Pediatr Congenit Heart Surg. 2022 Mar;13(2):203-207. doi: 10.1177/21501351221074617.
While frequently performed in the adult population, percutaneous coronary artery stent angioplasty (CSA) in infants is rare. CSA in infants is challenging because of limited options in terms of appropriately sized (length and diameter) stents, concern about stenting vessels with significant growth potential and limited data regarding durability of benefit. We report a multicenter case series of infants who underwent CSA.
A multicenter, retrospective case series of infants who underwent percutaneous CSA to treat post-operative coronary artery stenoses was performed.
Six infants from 3 institutions who underwent post-operative CSA were identified. The anatomic diagnoses were d-transposition of the great arteries in 3 cases, anomalous left coronary artery from the pulmonary artery in 2 and supravalvar aortic stenosis in 1. All infants were critically ill at the time of CSA. Diameters of coronary artery stents used ranged from 2.25 to 2.75 mm. There were no procedural complications. All stents were patent immediately after placement and the clinical condition improved or stabilized in all patients. Follow-up angiography was available for 3 patients at 4 to 16 months post-CSA, at which time 67% (2/3) remained patent.
CSA is a feasible and effective therapy for critically ill infants with post-surgical coronary obstruction. Treatment appears to allow at least short-term reperfusion to facilitate recovery of ventricular function and potential development of collateral circulation when longer-term stent patency is not achieved. Longer-term stent patency and coronary artery health remain unanswered questions.
经皮冠状动脉支架血管成形术（CSA）在成人中经常进行，但在婴儿中很少见。由于合适尺寸（长度和直径）的支架选择有限，担心对具有显著生长潜力的血管进行支架置入，以及关于获益持久性的数据有限，婴儿的CSA具有挑战性。我们报告了一组接受CSA的婴儿的多中心病例系列。
对接受经皮CSA治疗术后冠状动脉狭窄的婴儿进行了一项多中心回顾性病例系列研究。
确定了来自3个机构的6名接受术后CSA的婴儿。解剖诊断为大动脉转位3例，左冠状动脉起源于肺动脉异常2例，主动脉瓣上狭窄1例。所有婴儿在进行CSA时病情都很危急。使用的冠状动脉支架直径范围为2.25至2.75毫米。没有手术并发症。所有支架置入后立即通畅，所有患者的临床状况改善或稳定。3例患者在CSA后4至16个月进行了随访血管造影，此时67%（2/3）的支架仍保持通畅。
CSA是治疗术后冠状动脉梗阻的危重症婴儿的一种可行且有效的治疗方法。当无法实现长期支架通畅时，该治疗似乎至少能实现短期再灌注，以促进心室功能恢复和侧支循环的潜在发展。长期支架通畅和冠状动脉健康仍然是未解决的问题。
