Coronary Interventions in Pediatric Congenital Heart Disease.
Anastasia SchleigerPeter KramerStephan DreysseStephan SchubertBjörn PetersJoachim PhotiadisFelix BergerJohannes NordmeyerPublished in: Pediatric cardiology (2021)
Coronary artery lesions represent rare conditions in pediatric congenital heart disease and mainly include coronary artery stenoses (CAS) or coronary artery fistulae (CAF). Due to the small vessel size, pediatric percutaneous coronary interventions (PCI) are demanding and studies concerning long-term results are missing. In this retrospective study, we analyzed indications, procedural details, and post-procedural outcomes in pediatric patients who underwent PCI in our institution. For CAS treatment, procedural success was defined as efficient coronary revascularization with a significant improvement of coronary perfusion. CAF treatment was considered successful, when no residual shunt was detectable. From 1995 to 2020, 32 pediatric patients aged ≤ 18 years received interventional treatment for CAS (n = 24/32) or CAF (n = 8/32). Reasons for CAS were post-surgical (n = 15/24) or post-transplant (n = 9/24). Interventional treatment strategies included coronary angioplasty (20/43), stent placement (10/43), and a combination of both (13/43). In-hospital mortality occurred in 6/24 patients and late mortality in 5/24 patients leading to an overall 5-year survival of 62.5%. Early mortality mainly occurred due to post-ischemic myocardial failure. CAF occlusion was performed using coil embolization (n = 3), placement of vascular plugs (n = 3), a combination of both (n = 1), or a combination of coil embolization and a covered stent (n = 1). Treatment of coronary fistulae was successful in all patients with excellent post-procedural results and no follow-up death. PCI in pediatric patients with congenital heart disease can be performed safely and effectively. However, the overall 5-year survival probability of patients with CAS is reduced due to severe ischemic myocardial damage.
Keyphrases
- coronary artery
- coronary artery disease
- pulmonary artery
- congenital heart disease
- crispr cas
- percutaneous coronary intervention
- genome editing
- ejection fraction
- acute myocardial infarction
- newly diagnosed
- end stage renal disease
- cardiovascular events
- acute coronary syndrome
- aortic stenosis
- chronic kidney disease
- heart failure
- coronary artery bypass grafting
- st elevation myocardial infarction
- prognostic factors
- metabolic syndrome
- ultrasound guided
- left ventricular
- magnetic resonance imaging
- computed tomography
- smoking cessation
- pulmonary hypertension