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Heart 1999;81:166-170 ( February )
a Catheterisation
Laboratory, Children's Memorial Health Institute, Al Dzieci Polskich
20, 04-736 Warsaw-Miedzylesie, Poland, b Department of Paediatric Cardiology,
Guy's Hospital, London SE1, UK
Correspondence to: Dr Brzezinska-Rajszys.
Accepted for publication 6 October 1998
Objectives
To
determine outcome of stent implantation in patients with middle aortic syndrome.
DesignProspective
study, case series.
SettingA tertiary
paediatric cardiology centre in a children's hospital.
PatientsFive
patients, aged 4 to 17 years (mean 11.4 years), with upper limb
hypertension due to middle aortic syndrome.
InterventionStents
were implanted in the mid/lower thoracic/upper abdominal aorta.
Main outcome
measureSatisfactory deployment of stents and
blood pressure control.
ResultsIn all
patients, angiocardiography showed long segment stenosis in the mid or
lower thoracic/upper abdominal aorta. The pressure gradient was between
40 and 90 mm Hg (mean 63.2 mm Hg). Seven Palmaz stents were
implanted. Immediately after implantation, the gradient decreased to
between 0 and 35 mm Hg (mean 13.6 mm Hg). Angiography showed a
satisfactory result with widely patent stents in all. In one patient,
thrombosis of the stent occurred six days after implantation. This was
successfully treated with infusion of alteplase, further balloon
dilatation, and implantation of a second stent overlapping the first,
both dilated to 10 mm diameter. One patient had elective redilatation
of the stent six months after implantation, with further reduction of
the gradient from 35 mm Hg to 10 mm Hg. At the latest follow up
between three and 20 months (mean 12.2 months) after stent
implantation, in four patients blood pressure was better controlled
with antihypertensive drugs. One patient was normotensive without
drugs. Computed tomography showed no aneurysm formation in the region
of the stents.
ConclusionsStent
implantation is a preferable alternative to surgery in the treatment of
patients with middle aortic syndrome and merits further evaluation.
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