Faculty Collaboration Database

Coronary interventions in congenital heart diseases: from preterm to young adult patients. J Interv Cardiol 2013 Jun;26(3):287-94

Date

01/26/2013

Pubmed ID

23347195

DOI

10.1111/j.1540-8183.2013.12015.x

Scopus ID

2-s2.0-84879023496 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND: The small vessel size of infants and children makes interventional treatment of impaired coronary perfusion, such as stenoses, complete occlusions, and fistulae, demanding. Materials and techniques appropriate for this young age group have to demonstrate their ability to effectively treat these lesions.

METHODS AND RESULTS: Between 2004 and 2011, 14 patients with an age of 9 days to 25 years (median 4.6 years) and a bodyweight of 1.7-65 kg (median 14 kg) underwent coronary intervention. In 3 cases, emergency revascularization of the left coronary artery (CA) was performed successfully, followed by stent implantation in 1 patient. Embolization of coronary arterial fistulae with coils and vascular plugs was effective in 10 patients. An antegrade, retrograde or combined approach to achieve the most distal device placement preserved all side branches. One infant with pulmonary atresia and an intact ventricular septum was prepared for biventricular repair by step-by-step closure of the right ventricular to the CA connections. No procedure-related deaths occurred.

CONCLUSION: Congenital and post-procedural coronary obstructive lesions can be considered for effective treatment with balloon dilation at any age as a salvage procedure. In coronaries impaired by external compression, stent implantation can restore perfusion, but long-term results are missing. Interventional closure of coronary fistulae has shown improvement of coronary arterial perfusion. The latter techniques can be used to close right ventricular to CA connections in patients with pulmonary atresia to prepare for biventricular repair, but bail-out strategies should be planned in all coronary interventions.

Author List

Schneider M, Wiebe W, Hraška V, Zartner P

Author

Viktor Hraska MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Angioplasty, Balloon, Coronary
Child
Child, Preschool
Coronary Artery Disease
Coronary Vessels
Female
Follow-Up Studies
Heart Defects, Congenital
Humans
Infant
Infant, Newborn
Male
Treatment Outcome
Young Adult