PCI can be viable bridge to revascularization

A coronary stent is a viable option as a bridge to a surgical revascularization or heart transplant in infants and young children with coronary stenosis. Researchers described their experience with 7 children who underwent percutaneous coronary intervention (PCI) at Rady Children's Hospital in San Diego.

Of the 7 children, 4 were younger than 15 months. Indications for PCI were congenital ostial stenosis; worsening of symptoms of acute coronary syndrome after surgical repair of anomalous left coronary artery arising from the pulmonary artery; and acute left ventricular dysfunction and ventricular fibrillation secondary to external compression of the left main coronary artery after dilation of a right pulmonary artery stent.

The average amount of time before another intervention was needed was 434 days. The longest period free from further intervention was 3 years. Bare metal stents were chosen for all the children younger than 15 months, with an immediate success rate of 100% (complete recanalization of stented coronary segments with satisfactory filling of supplied distal branches).

Even though the risk of PCI is lower than that of surgery, "it should be performed only in urgent or emergent situations," and extracorporeal membrane oxygenation support should be readily available.

Bratincsák A, Salkini A, El-Said HG, Moore JW. Percutaneous stent implantation into coronary arteries in infants. Cathet Cardiovasc Intervent. 2011;doi:10.1002/ccd.23173.