Antegrade Implantation of Big Stents in the Aortic Isthmus of Small Children

  • Dr Christoph Schmitz, Department of Cardiac Surgery, University of Munich, Germany, Germany
  • Dr Bahman Esmaillzadeh, Department of Cardiac Surgery, University of Bonn, Germany, Germany
  • Dr Ulrike Herberg, Department of Pediatric Cardiology, University of Bonn, Germany, Germany
  • Dr Nora Lang, Department of Pediatric Cardiology, University of Munich, Germany, Germany
  • Dr Ralf Sodian, Department of Cardiac Surgery, University of Munich, Germany, Germany
  • Dr Rainer Kozlik-Feldmann, Department of Pediatric Cardiology, University of Munich, Germany, Germany
  • Prof Armin Welz, Department of Cardiac Surgery, University of Bonn, Germany, Germany
  • Dr Johannes Breuer, Department of Pediatric Cardiology, University of Bonn, Germany, Germany

    • Objective: Implantation of stents into the aortic isthmus is usually not done in very small children, because the children rapidly “outgrow” these stents. Implantation of large stents is not possible because of poor peripheral vascular access. Antegrade implantation via the ascending aorta might be the answer to overcome this issue.

    Methods: Between 01/2000 and 04/2007 6 patients with hypoplastic left heart syndrome developed coarctation after first stage palliation with bovine pericardium. Stent implantaion was performed during the PCPC operation. After weaning from cardio-pulmonary bypass the aortic cannula was exchanged to a 10 F sheath. The CP stent (8Z16, pfm, Cologne, Germany) was introduced under fluoroscopic guidance.

    Results: The stent could be placed in all patients. Gradient via the coarcation dropped from x ± x mmHg to x ± x mmgHg. The isthmus stent was re-dilated In x children in the meantime.

    Conclusions: In order to overcome vascular access problems antegrade stent implantation might be an option. Stents implanted via the ascending aorta can be easily dilated up to 25 mm, which should be sufficient even for adults.