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Stent Implantation for Coarctation of the Aorta in Children <30 kg

Uthara R. Mohan, MD, Saar Danon, MD^_*,, Daniel Levi, MD^_*, Dana Connolly, PhD, John W. Moore, MD, MPH^_*,,_*

^_* Mattel Children's Hospital at UCLA, Los Angeles, California
Rady Children's Hospital and UCSD, San Diego, California

^_* Reprint requests and correspondence: Dr. John W. Moore, Section of Pediatric Cardiology, UCSD, Rady Children's Hospital–San Diego, 3020 Children's Way, MC 5004, San Diego, California 92123 (Email: jmoore{at}rchsd.org).

Objectives: Our aim was to determine key characteristics of stents commonly implanted in the aorta through bench testing and to describe our technique and acute results in patients weighing <30 kg.

Background: Despite the increasing use of stents for interventional treatment for coarctation of the aorta (CoA) in larger patients, use of large stents is controversial in small children.

Methods: Methods included bench testing of large stents, and retrospective review of all patients over 1 year of age who had stent implantation for treatment of CoA. Patients were divided into 2 groups based on weight. Paired comparisons were made before and after stent implantation, and group outcomes were compared.

Results: Sixty patients comprised the entire sample, with 22 patients assigned to group I (<30 kg) and 38 patients assigned to group II (30 kg). The mean minimum diameters of the CoA (group I 5.0 to 10.7 mm; group II 8.0 to 15.0 mm) and the ratio of the coarctation diameter to the descending aorta diameter measured at the level of the diaphragm (CoA/DAo ratio) (group I 0.4 to 0.93; group II 0.46 to 0.94) increased significantly in both groups (all p < 0.05). The mean systolic gradient decreased significantly in both groups (group I 23.0 to 2.0 mm Hg; group II 24.0 to 2.8 mm Hg; both p = 0.001). No difference was found between the groups in the CoA/DAo ratio, residual systolic gradients, or the decrease in systolic gradient after stent implantation. There were no significant complications in patients under 30 kg.

Conclusions: As in larger patients, use of large stents for treatment of CoA in small children is effective and safe in the short term. In these patients, stent redilations will be required, and follow-up is ongoing.

Key Words: coarctation of aorta • stent • angioplasty • pediatric heart disease • congenital heart disease • pediatric interventional cardiology

Abbreviations and Acronyms   CoA = coarctation of the aorta   CoA/DAo ratio = the ratio of the coarctation diameter to the descending aorta diameter measured at the level of the diaphragm

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