Covered Stent Implantation into the Right Ventricular Outflow Tract in Infants with TOF/PA + VSD and Diminutive Pulmonary Arteries

Objectives: Right ventricular outflow tract (RVOT) stenting is a palliative treatment option in symptomatic infants with the tetralogy of Fallot (ToF) or in patients with pulmonary atresia and ventricular septal defect (PA + VSD). We present our experience in patients who were treated with covered coronary stent graft implantation into the RVOT.

Methods: Between November 2017 and August 2020 the covered coronary stent grafts was used to open or widen the RVOT in 14 patients. Efficacy and safety of the catheter intervention was assessed and follow-up data were collected.

Result: The study group consists of 14 patients (8 males, PA + VSD: 4 patients; ToF: 10 patients; and 6 patients with arterial duct dependent pulmonary circulation). The median age of the patients was 25 (3–306) days, the median body weight 3.2 (1.89–6.5) kg. The diameters of the implanted stents were 3.5 to 5 mm. All stents were implanted successfully. Median time of palliation was 140 (28–835) days. Nine patients required an additional stent implantation to relieve a proximal obstruction in the RVOT. There were two complications: RVOT perforation (resolved without treatment), one patient and stent embolization to the aorta (surgical removal), one patient. All stents were patent during the follow-up time, and we observed significant increase in a diameter of pulmonary artery and its branches after the procedure (p < 0.02). So far, eight patients had corrective surgery performed.

Conclusion: RVOT stenting with covered coronary stent grafts in young cyanotic patients with diminutive pulmonary arteries not being amenable for surgical primary correction was safe and effective and may prevent a surgical palliation. During corrective surgery, covered stents may be removed more easily than bare metal stents.

Publication History

Article published online:
21 February 2021