The CP stent--short, long, covered--for the treatment of aortic coarctation, stenosis of pulmonary arteries and caval veins, and Fontan anastomosis in children and adults: an evaluation of 60 stents in 53 patients

Abstract

Objective: To evaluate the feasibility and usefulness of the Cheatham platinum (CP) stent in a broad spectrum of lesions.

Methods: Retrospective analysis of 60 implanted CP stents (11-80 mm lengths, 12 covered) between September 2001 and March 2004.

Patients: 53 patients aged 2.5-68 years (median 17 years). Body weight ranged from 12-95 kg (median 52 kg). Thirty six patients had aortic (re)coarctation; seven of them had functionally interrupted aortic arches. Thirteen patients had pulmonary artery stenosis and four had stenosis of caval veins or conduits in a total cavopulmonary connection (TCPC).

Results: Arterial pressure gradients dropped from 33 mm Hg (range 20-80 mm Hg) to 5 mm Hg (range 0-10 mm Hg) and pressure gradients in TCPC or caval veins dropped from 4 mm Hg (range 4-20 mm Hg) to 0 mm Hg (range 0-3 mm Hg). All stents were placed in the target lesion without complications. Three stent fractures without clinical instability were noted.

Conclusions: The CP stent is suitable for the treatment of vessel stenosis in congenital heart diseases from childhood to adulthood. Whether these good results will be stable in the long term needs to be investigated.

Figure 1

Implantation of a 39 mm covered Cheatham platinum (CP) stent for the treatment of subatretic aortic coarctation. (A) Composite of two frames of the same angiogram (early and late phase). The procedure was performed in two steps: (B) firstly, the stent was implanted with only moderate dilatation of the subatretic area; (C) then after six months the stent was definitively dilated to completely relieve the stenosis.

Figure 2

The shortest stent in this series was an 11 mm stent in the transverse aortic arch of an 8 year old boy. (A) Before implantation; (B) after implantation.

Figure 3

The largest stent used in this series was an 80 mm covered stent in a patient with recoarctation and aneurysm 30 years after surgery. (A) Before implantation; (B) after implantation.

Figure 4

(A) Subatretic aortic coarctation in a 3 year old child weighing 14 kg. (B) Balloon dilatation did not achieve sufficient pressure reduction, so that a 22 mm CP stent on a 10 mm balloon was implanted, which led to a reduction of the pressure gradient from 60 mm Hg to 5 mm Hg.

Figure 5

(A) Severe stenoses of right and left pulmonary arteries in an adult patient (35° left anterior oblique, 36° cranial). (B) Complete relief of the pressure gradients after consecutive implantation of two CP stents (8 zig, 28 mm each) and dilatation with a 16 mm balloon (20° right anterior oblique, 45° cranial). The smooth edges of the contralateral stent minimise the risk of balloon rupture.

Figure 6

Patient with total cavopulmonary anastomosis by an intra-atrial tunnel and connection of the right atrial appendage to the pulmonary trunk. (A) A stenosis (arrow) at the atrial-arterial junction was treated with implantation of a 28 mm. (B) CP stent dilated to a diameter of 22 mm.

Figure 7

Sonography of the femoral artery (*) of a 2.5 year old boy with a body weight of 15 kg three days after implantation of a CP stent through a 9 French sheath. (A) The access site can be seen (blue arrow) but with no anatomical stenosis. (B) Colour Doppler showing laminar unobstructed flow across the vessel.