Studies examine issues in pediatric cardiology

Progress made in understanding cardiovascular disease, surgery options in pediatric patients

Heart problems in children are quite different from those in adults, and four studies presented today at the American College of Cardiology’s 56th Annual Scientific Session look at how pediatric cardiologists take different approaches to better understand and manage cardiovascular disease in this population, including insights into fundamental cardiac mechanisms and testing of new procedures. ACC.07 is the premier cardiovascular medical meeting, bringing together cardiologists and cardiovascular specialists to further breakthroughs in cardiovascular medicine.

"Congenital heart disease is one of the most common birth defects seen in the United States today, and it is important we continue supporting research that will improve the diagnosis and treatment of infants, children and young adults with these problems,” said Roberta Williams, M.D., of the Children's Hospital of Los Angeles. “These studies show how a better understanding of new technologies can save lives and establish a better quality of life for children living with cardiovascular disorders.”

Long-term Follow-up of Stents Placed in Infants with Congenital Heart Disease (Presentation Number 1017-27)

Stents have been credited with saving thousands of lives by treating blocked coronary arteries. While the implantation of balloon-expandable stents in infants has been shown to be technically feasible, there is essentially no long-term data showing that this treatment remains effective as an infant grows. In order to determine the benefits of stent implantation in infants, researchers from Miami Children’s Hospital in Florida conducted a retrospective analysis on the earliest consecutive series of infants who underwent stent placement between October 1995 and December 1999.

During this time period, 33 stent implantations were attempted in 27 infants. Implants were successful in 94 percent of these patients (n=31). Three non-procedure related deaths were reported within 30 days of implantation, one patient was lost to follow-up and one experienced acute thrombosis of the stent. The remaining 22 patients, which account for 26 of the stent implantations, were analyzed for this follow-up study.

Patients were followed for an average of 101 months following stent implantation. A total of 44 re-catheterizations were performed over this time period, during which 19 stents in 17 patients underwent 32 re-dilations. There were no procedural complications or deaths during these follow-up procedures. At the most recent catheterization (63 months post-implant on average) in patients who underwent re-dilation, researchers noted an increase in stent diameter of 24 percent since initial implantation, suggesting that these devices can be effectively enlarged to keep pace with a young child’s normal growth.

Seven stents were electively removed at the time of a planned cardiac surgery without complications and all remaining stents (n=18) are currently free of significant obstruction. At the latest study follow-up, 21 of 22 patients are alive and well, with one unrelated death occurring 51 months after stent implantation.