The outcome of percutaneous stent implantation in congenital heart disease: experience of a single institute

Abstract

Purpose: The efficacy of percutaneous stent implantation for congenital heart disease (CHD) in Korea, where stent availability is limited, has not been determined. This study evaluated the acute and midterm results of stent implantation in different CHD subgroups.

Methods: Stents were implanted in 75 patients with 81 lesions: (1) pulmonary artery stenosis (PAS) group, 56 lesions in 51 patients; (2) coarctation of the aorta (CoA) group, 5 lesions in 5 patients; (3) Fontan group, 13 lesions in 12 patients; (4) ductal stent group, 3 lesions in 3 patients; and (5) other CHD group, 4 lesions in 4 patients. Mean follow-up duration was 2.1 years (0.1-4 years). Medical records were reviewed retrospectively.

Results: The minimum lumen diameter (MLD) in PAS and CoA increased from 5.0±1.9 mm and 8.4±1.6 mm to 10.1±3.6 mm and 12.3±2.5 mm, respectively (P<0.01). In the PAS group, pressure gradient decreased from 25.7±15.6 mmHg to 10.4±10.1 mmHg, and right ventricular to aortic pressure ratio from 0.56±0.21 to 0.46±0.19. In the CoA group, the pressure gradient decreased from 50±33 mmHg to 17±8 mmHg. In the ductal stent group, the MLD of the ductus increased from 2.3 mm to 4.3 mm and arterial oxygen saturation from 40%-70% to 90%. No deaths were associated with stent implantation. Stent migration occurred in 3 patients, but repositioning was successful in all. Stent redilation was performed successfully in 26 cases after 29±12 months.

Conclusion: Percutaneous stent implantation was safe and effective, with acceptable short and mid-term outcomes in Korean CHD patients.

Keywords: Congenital heart disease; Mid-term outcome; Percutaneous stent implantation.

Fig. 1. (A) Minimum lumen diameter before (5.0±1.9 mm) and after (10.1±3.6 mm) stent implantation in the pulmonary artery stenosis group. (B) Pressure gradient before (25.7±15.6 mmHg) and after (10.4±10.1 mmHg) stent implantation in the pulmonary artery stenosis group. (C) Right ventricular to aortic pressure ratio before (0.56±0.21) and after (0.46±0.19) stent implantation in the pulmonary artery stenosis group.

Fig. 2. (A) Minimum lumen diameter before (8.4±1.6 mm) and after (12.3±2.5 mm) stent implantation in the coarctation of the aorta group. (B) Pressure gradient before (50±33 mmHg) and after (17±8 mmHg) stent implantation in the coarctation of the aorta group.

Fig. 3. Freedom from reintervention rate after stent implantation.

Fig. 4. (A) Left ventricular angiogram showing left ventricular outflow tract (LVOT) obstruction. (B) LVOT stenting with 4014 Palmaz stent during left ventricular assist device (LVAD) implantation. (C) Stent fracture 12 months after stenting. VSD, ventricular septal defect; LV, left ventricular.