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Stenting the paediatric heart
  1. Alain Fraisse
  1. Dr A Fraisse, Cardiologie Pédiatrique, Hôpital d’Enfants de La Timone, 264, rue Saint-Pierre, 13385 Marseille, France; alain.fraisse{at}ap-hm.fr

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The concept of intravascular stent implantation was first described by Dotter et al in 1969 in an animal model.1 However, balloon expendable intravascular stenting was not carried out until two decades later after improvements in stent design and technology. Clinical trials were first performed in the late 1980s in adults with coronary artery obstructions.2 Soon, Mullins and other paediatric interventionalists adopted the Palmaz stent designed by Julio Palmaz for iliac, biliary, renal and intrahepatic porta-caval shunt. They used it in virtually all vascular obstructions associated with congenital heart diseases.3 In 1992, stenting was first applied in right ventricular outflow tract (RVOT) conduit obstruction resistant to balloon angioplasty.4 More extensive clinical experience demonstrated that stenting effectively prolongs RVOT conduit lifespan.5 Recent advances in balloon-expendable stent technology provided through valved stents a novel therapy for both RVOT conduit obstruction and regurgitation.6

In this issue of Heart (see page 142),7 Dohlen and colleagues further extend the field of stenting in paediatric cardiology through stent implantation in the intracardiac obstructive RVOT. The authors reviewed retrospectively the effectiveness of RVOT stenting in nine symptomatic infants with tetralogy of Fallot, hypoplastic pulmonary valve and arteries. Their procedure was successful in all cases. RVOT stenting significantly improved arterial oxygen saturation from 73% (range 60–85%) to 94% (90–98%) (p = 0.008) and pulmonary artery growth through augmentation of the median Z score for the right and left pulmonary artery. The Nakata index increased from 56 mm2/m2 (21–77) to 150 mm2/m2 (123–231) (p = 0.008). Six of the nine children underwent surgical repair at a median age of 142 days with no mortality. The authors conclude that RVOT stenting provides a safe and effective management strategy and should be used as a prelude to corrective surgical in severely cyanotic …

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