Experimental studies on the implantation of intravascular stents in puppies—potential use for aortic coarctation and pulmonary arterial stenosis

AbstractWe have investigated angiographically and histologically the vascular response to implantation of intravascular stents in normal puppies. Eight balloon-expandable stents were placed in six mongrel puppies (weight 6.4–10.5 kg) under anesthesia. Four stents were successfully placed in the pulmonary arteries and three in the aorta. In one case, the strut of the stent was hooked by a leaflet of the tricuspid valve at the time of placement and eventually had to be implanted in the inferior caval vein. Two puppies died, one from bleeding from the femoral artery and the other from thrombotic obstruction at the superior mesenteric artery, both after successful implantation. The former was due to repeat arterial puncture and the latter wasdue to failure to use aspirin. Angiographic studies showed satisfactory opacities of the branch arteries in all but one puppy. The diameter of the arteries prior to implantation was 7.5±1.5 mm. The diameters at the middle of the stents immediately after implantation and during the period of follow-up were 6.9±1.7mm and 6.9±2.1 mm, respectively. Histologic studies revealed that neogenic endothelial layers of 30 to 40 pm in thickness had formed over the struts of the stent without formation of thrombusthree weeks after implantation. Scanning electron microscopy revealed that the endothelial cells of the neoendothelial layer had almost identical characteristics to those of normal arteries. These results indicate that clinical application of this stent is feasible but that use of anticoagulants is mandatory during and after implantation in the treatment of selected patients with aortic coarctation or pulmonary arterial stenosis. Relative progression of stenosis may occur, however, and the inability for re-expansion is a major disadvantage of this stent.

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Long-term follow-up of stents implanted to relieve peripheral pulmonary arterial stenosis: hemodynamic findings and results of lung perfusion scanning

Cardiology in the Young ◽

10.1017/s104795110000562x ◽

1999 ◽

Vol 9 (6) ◽

pp. 585-591 ◽

Cited By ~ 10

Author(s):

Isabella Spadoni ◽

Sandra Giusti ◽

Pietro Bertolaccini ◽

Alberto Maneschi ◽

Giuliano Kraft ◽

...

Keyword(s):

Systolic Pressure ◽

Lung Perfusion ◽

Arterial Stenosis ◽

Long Term Follow Up ◽

Pulmonary Arterial ◽

Late Restenosis ◽

Systolic Pressure Gradient ◽

Pulmonary Arterial Stenosis

AbstractIn recent years, percutaneous placement of stents has been used as an alternative to surgery or balloon angioplasty for the treatment of adults with peripheral pulmonary arterial stenosis. This therapy has also been proposed for children, but questions still remain about its indications in this group of patients. We describe here the results of intravascular placement of stents in a group of 29 patients, with a mean age of 12±7 (range 3–31) years and weighing 35 ±19 (range 11–74) kg. All were affected by postsurgical or congenital isolated pulmonary arterial stenosis, and have now been followed for 38 ±19 (range 6–65) months. The early hemodynamic results have been excellent, with a significant reduction of the pulmonary arterial systolic pressure, the systolic pressure gradient, and the ratio of systolic pressures in the pulmonary and systemic circuits, and with a significant increase of the diameter of the stented vessels in all the patients. Of the 29 patients, 24 have been recatheterized 18 ± 10 months after the procedure, demonstrating the stability of the results, with a low incidence of late restenosis, this seen in only 1 patient (2°). Lung perfusion scanning, performed in 17 patients each year after the follow-up catheterization, has showed that the results are maintained at long-term follow-up (51 ±9 months).

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Morphologic changes in the pulmonary arteries after percutaneous balloon angioplasty for pulmonary arterial stenosis.

Circulation ◽

10.1161/01.cir.71.2.195 ◽

1985 ◽

Vol 71 (2) ◽

pp. 195-201 ◽

Cited By ~ 49

Author(s):

B S Edwards ◽

R V Lucas ◽

J E Lock ◽

J E Edwards

Keyword(s):

Balloon Angioplasty ◽

Pulmonary Arteries ◽

Arterial Stenosis ◽

Percutaneous Balloon ◽

Percutaneous Balloon Angioplasty ◽

Pulmonary Arterial ◽

Pulmonary Arterial Stenosis ◽

Morphologic Changes

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Early definitive repair of tetralogy of Fallot: a review of 74 cases

Cardiology in the Young ◽

10.1017/s1047951100004133 ◽

1997 ◽

Vol 7 (3) ◽

pp. 254-257 ◽

Cited By ~ 1

Author(s):

Dan Abramov ◽

Jacob Barak ◽

Ehud Raanani ◽

Einat Birk ◽

Bernardo A. Vidne

Keyword(s):

Tetralogy Of Fallot ◽

Prolonged Mechanical Ventilation ◽

Pulmonary Arteries ◽

Balloon Dilation ◽

Arterial Stenosis ◽

Definitive Repair ◽

Pulmonary Arterial ◽

Definitive Surgery ◽

One Year ◽

Pulmonary Arterial Stenosis

AbstractDefinitive repair of tetralogy of Fallot was performed on 74 patients under two years of age, including 40 under the age of one year and 13 less than 6 months of age. In six patients, there had been previous construction of a systemic-to-pulmonary arterial shunt. Patching across the ventriculo-pulmonary junction was required in 46 patients, placement of conduits in six, and procedures producing unifocaliza-tion in three. Three patients died during the 60-day postoperative period of observation. Of the 71 survivors, 64 recovered without complications. One patient had neurologic sequels, one required prolonged mechanical ventilation, two reoperation, and one balloon dilation of residual left pulmonary arterial stenosis. Morbidity and mortality were not significantly higher in those patients undergoing surgery at earlier than 6 months of age, although transjunctional patching was more common in that age group. Previous construction of a shunt was associated with a higher prevalence of distal stenosis and distortion of the pulmonary arteries, which needed surgical repair in two out of six patients (33%). Since the outcome of definitive repair is favourable in patients with tetralogy of Fallot younger than six months of age, we now advocate definitive surgery for all young symptomatic patients by the age of six months.

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In situ fracture of stents implanted for relief of pulmonary arterial stenosis in patients with congenitally malformed hearts

Cardiology in the Young ◽

10.1017/s1047951108002424 ◽

2008 ◽

Vol 18 (4) ◽

pp. 405-414 ◽

Cited By ~ 29

Author(s):

Doff B. McElhinney ◽

Lisa Bergersen ◽

Audrey C. Marshall

Keyword(s):

Cohort Analysis ◽

Pulmonary Arteries ◽

Arterial Stenosis ◽

Related Factors ◽

Increased Risk ◽

Right Pulmonary Artery ◽

Pulmonary Arterial ◽

The Right ◽

Pulmonary Arterial Stenosis

AbstractBackgroundOne of the most common uses of stents in patients with congenitally malformed hearts is treatment of pulmonary arterial stenosis. Although there are reports of fractured pulmonary arterial stents, little is known about the risk factors for, and implications of, such fractures.MethodsWe reviewed angiograms to identify fractures in stents previously inserted to relieve stenoses in pulmonary arteries from 1990 through 2001 in patients who also underwent follow-up catheterization at least 3 years after placement of the stent. We undertook matched cohort analysis, matching a ratio of 2 fractured to 1 unfractured stent.ResultsOverall, 166 stents meeting the criterions of our study had been placed in 120 patients. We identified fractures in 35 stents (21%) in 29 patients. All fractured stents were in the central pulmonary arteries, 24 (69%) in the central part of the right pulmonary artery, and all were complete axial fractures, or complex fractures along at least 2 planes. Stent-related factors associated with increased risk of fracture identified by multivariable logistic regression included placement in close apposition to the ascending aorta (p = 0.001), and a larger expanded diameter (p = 0.002). There was obstruction across 28 of 35 fractured stents, which was severe in 11. We re-stented 21 of the fractured stents, and recurrent fracture was later diagnosed in 3 of these. A fragment of the fractured stent embolized distally in 2 patients, without clinically important effects.ConclusionsIn situ fracture of pulmonary arterial stents is relatively common, and in most cases is related to compression by the aorta. There is usually recurrent obstruction across the fractured stent, but fractured stents rarely embolize, and are not associated with other significant complications.

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Arteriohepatic dysplasia: Familial pulmonary arterial stenosis with neonatal liver disease

Archives of Disease in Childhood ◽

10.1136/adc.48.6.459 ◽

1973 ◽

Vol 48 (6) ◽

pp. 459-466 ◽

Cited By ~ 172

Author(s):

G. H. Watson ◽

V. Miller

Keyword(s):

Liver Disease ◽

Arterial Stenosis ◽

Arteriohepatic Dysplasia ◽

Neonatal Liver ◽

Pulmonary Arterial ◽

Pulmonary Arterial Stenosis

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Arteriohepatic Dysplasia: Association of Liver Disease with Pulmonary Arterial Stenosis as Well as Facial and Skeletal Abnormalities

PEDIATRICS ◽

10.1542/peds.66.6.876 ◽

1980 ◽

Vol 66 (6) ◽

pp. 876-883

Author(s):

Solomon E. Levin ◽

Paniyotis Zarvos ◽

Selwyn Milner ◽

Arthur Schmaman

Keyword(s):

Liver Disease ◽

Coronary Artery ◽

Clinical Features ◽

Arterial Stenosis ◽

Viral Etiology ◽

Congenital Rubella ◽

Arteriohepatic Dysplasia ◽

Pulmonary Arterial ◽

The Right ◽

Pulmonary Arterial Stenosis

The clinical features and course of five children with the recently described syndrome of arteriohepatic dysplasia are presented. All had bilateral pulmonary arterial stenosis, proven at cardiac catheterization, as well as associated liver disease of varying severity. In one of the fatal cases, a hitherto undescribed anomaly was found—stenosis of the right coronary artery ostium. A viral etiology, eg, the congenital rubella syndrome, was considered most likely, but detailed investigations proved to be negative.

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Stent Implantation in Patients with Pulmonary Arterial Stenosis

Atlas of Cardiac Catheterization for Congenital Heart Disease ◽

10.1007/978-3-319-72443-0_13 ◽

2019 ◽

pp. 111-119

Author(s):

Andreas Eicken ◽

Peter Ewert

Keyword(s):

Stent Implantation ◽

Arterial Stenosis ◽

Pulmonary Arterial ◽

Pulmonary Arterial Stenosis

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Isolated pulmonary arterial stenosis caused by Takayasu's arteritis in an elderly male

Journal of Cardiology ◽

10.1016/j.jjcc.2007.12.003 ◽

2008 ◽

Vol 51 (3) ◽

pp. 196-200 ◽

Cited By ~ 14

Author(s):

Yusuke Fukuda ◽

Kazuyuki Shirai ◽

Yosuke Takamiya ◽

Miller Nathan ◽

Takahiro Mito ◽

...

Keyword(s):

Takayasu’S Arteritis ◽

Arterial Stenosis ◽

Takayasu's Arteritis ◽

Elderly Male ◽

Pulmonary Arterial ◽

Pulmonary Arterial Stenosis

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Repair of tetralogy of Fallot associated with atrioventricular septal defect

Cardiology in the Young ◽

10.1017/s1047951100004728 ◽

1998 ◽

Vol 8 (1) ◽

pp. 105-112 ◽

Cited By ~ 6

Author(s):

Tomás̆ Tláskal ◽

Bohumil Huc̆ín ◽

Martin Kostelka ◽

Václav Chaloupecký ◽

Jan Marek ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

Septal Defect ◽

Pulmonary Stenosis ◽

Pulmonary Arteries ◽

Pulmonary Regurgitation ◽

Atrioventricular Septal Defect ◽

Arterial Stenosis ◽

Long Term Results

AbstractTetralogy of Fallot, when associated with atrioventricular septal defect permitting shunting at ventricular level, represents a complex cyanotic congenital malformation. Experience with surgical repair is limited, and results vary considerably. Between 1984 and 1996, we repaired 14 consecutive patients with this combination seen in our center. Their ages ranged from 8 months to 21 years (median 7.4 years). Six (42.9%) had Down's syndrome. In eight patients the correct diagnosis was made using echocardiogra phy alone. In the remaining six patients, who had previously-constructed arterial shunts and/or suspected pulmonary arterial stenosis, catheterization and angiocardiography were also performed. The repair consisted of double patch closure of the septal defect, reconstruction of two atrioventricular orifices, and relief of pulmonary stenosis at all levels. In five patients with a hypoplastic pulmonary trunk, a monocusp transannular patch (four patients) or an allograft (one patient) was used for restroration of continuity from the right ventricle to the pulmonary arteries. Patch enlargement of one or both pulmonary arteries was necessary in five patients. One patient (7.1%) died early, and another late. The twelve surviving (85.8%) patients have been followed for 1.2–12.5 years after surgery (median 4.9 years, mean 5.9 ± 3.9 years). During the follow-up, reoperation was necessary for repair of residual ventricular septal defect and pulmonary regurgitation in two patients, and closure of an atrial septal defect and alteration to left atrioventricular valvar regurgitation in one patient. Seven patients are in class I of the New York Heart Association, four in class II, and one in class III. Tetralogy of Fallot associated with atrioventricular septal defect can be corrected with low mortality and good long-term results. Residual lesions, however, have a tendency to progress, especially when seen in combination. After surgery, all patients need long-term close follow-up.

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