Pediatric Cardiology

, Volume 38, Issue 7, pp 1441–1449 | Cite as

Stent Therapy for Aortic Coarctation in Children <30 kg: Use of the Low Profile Valeo Stent

  • Sok-Leng Kang
  • Andrew Tometzki
  • Demetris Taliotis
  • Robin Martin
Original Article


To report our experience of coarctation stent therapy in small children weighing less than 30 kg, with the low profile dilatable Valeo stent and review the literature on coarctation stent therapy in this patient population. Coarctation stent implantation was undertaken in 14 consecutive children using the Bard Valeo Stent. Demographic, angiographic, echocardiographic and clinical data were reviewed retrospectively. The median age at the time of procedure was 5.1 (2.6–7.5) years and median weight was 20.8 (14.7–27) kg. There was improvement in median coarctation diameter from 4 (1.3–5.2) to 9.5 (5.8–12.7) mm, p < 0.001; and a reduction in the median peak pressure gradient across the coarctation from 35 (20–49) to 9 (0–15) mmHg, p < 0.001. Median stent recoil was 7.9 (0–20)%. There was one case of access related complication that resolved without sequelae. Follow-up was a median of 15 (3.0–57.2) months. CT angiogram performed at a median time of 3.3 (2.6–10.2) months post procedure showed no aortic wall injury and preserved stent integrity in all cases. Two children underwent re-intervention for stent dilation and further stent implantation due to in-stent stenosis and somatic growth after 3 years. Six of fourteen children remained on a single antihypertensive agent post-intervention at last follow-up. Implantation of the dilatable Valeo stent is a feasible treatment strategy in native or recurrent coarctation in small children, accepting that additional stent implantation may be necessary with somatic growth. Further study is required to determine longer-term stent efficacy and clinical outcome.


Aortic coarctation Child Cardiac catheterization Stents 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Forbes TJ, Kim DW, Du W et al (2011) Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC (congenital cardiovascular interventional study consortium). J Am Coll Cardiol 58:2664–2674CrossRefPubMedGoogle Scholar
  2. 2.
    Carr JA (2006) The results of catheter-based therapy compared with surgical repair of adult aortic coarctation. J Am Coll Cardiol 47:1101–1107CrossRefPubMedGoogle Scholar
  3. 3.
    Chessa M, Carrozza M, Butera G et al (2005) Results and mid-long-term follow-up of stent implantation for native and recurrent coarctation of the aorta. Eur Heart J 26:2728–2732CrossRefPubMedGoogle Scholar
  4. 4.
    Hamdan MA, Maheshwari S, Fahey JT et al (2001) Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol 38:1518–1523CrossRefPubMedGoogle Scholar
  5. 5.
    Johnston J, Kelley RI, Feigenbaum A et al (1997) Mutation characterization and genotype-phenotype correlation in Barth syndrome. Am J Hum Genet 61:1053–1058CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    O’Laughlin MP, Perry SB, Lock JE et al (1991) Use of endovascular stents in congenital heart disease. Circulation 83:1923–1939CrossRefPubMedGoogle Scholar
  7. 7.
    Shepherd E, Connolly GM, Morgan G (2013) Using the Valeo dilatable stent in coarctation stenting for small children: expanding the inclusion criteria for coarctation stenting? BMJ Case Rep. doi: 10.1136/bcr-2013-202095 Google Scholar
  8. 8.
    Stern HJ, Baird CW (2009) A premounted stent that can be implanted in infants and re-dilated to 20 mm: introducing the Edwards Valeo lifestent. Catheter Cardiovasc Interv 74:905–912CrossRefPubMedGoogle Scholar
  9. 9.
    Travelli FC, Sullivan PM, Takao C et al (2016) The Valeo stent: a pre-mounted, open-cell, large stent for use in small children with CHD. Cardiol Young 26:1187–1193CrossRefPubMedGoogle Scholar
  10. 10.
    Butera G, Giugno L, Basile D et al (2015) The Edwards Valeo lifestents in the treatment and palliation of congenital heart disease in infants and small children. Catheter Cardiovasc Interv 86:432–437CrossRefPubMedGoogle Scholar
  11. 11.
    Golden AB, Hellenbrand WE (2007) Coarctation of the aorta: stenting in children and adults. Catheter Cardiovasc Interv 69:289–299CrossRefPubMedGoogle Scholar
  12. 12.
    Bondanza S, Calevo MG, Marasini M (2016) Early and long-term results of stent implantation for aortic coarctation in pediatric patients compared to adolescents: a single center experience. Cardiol Res Pract 2016:4818307. doi: 10.1155/2016/4818307 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Baykan A, Narin N, Ozyurt A et al (2014) Cheatham platinum stent implantation in children with coarctation of the aorta: single-centre short-term, intermediate-term, and long-term results from Turkey. Cardiol Young 24:675–684CrossRefPubMedGoogle Scholar
  14. 14.
    Thanopoulos BD, Giannakoulas G, Giannopoulos A et al (2012) Initial and six-year results of stent implantation for aortic coarctation in children. Am J Cardiol 109:1499–1503CrossRefPubMedGoogle Scholar
  15. 15.
    Cheatham JP (2001) Stenting of coarctation of the aorta. Catheter Cardiovasc Interv 54:112–125CrossRefPubMedGoogle Scholar
  16. 16.
    Thanopoulos BD, Hadjinikolaou L, Konstadopoulou GN et al (2000) Stent treatment for coarctation of the aorta: intermediate term follow up and technical considerations. Heart 84:65–70CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Mohan UR, Danon S, Levi D et al (2009) Stent implantation for coarctation of the aorta in children <30 kg. JACC Cardiovasc Interv 2:877–883CrossRefPubMedGoogle Scholar
  18. 18.
    Schaeffler R, Kolax T, Hesse C et al (2007) Implantation of stents for treatment of recurrent and native coarctation in children weighing less than 20 kilograms. Cardiol Young 17:617–622CrossRefPubMedGoogle Scholar
  19. 19.
    Forbes TJ, Garekar S, Amin Z et al (2007) Procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age: a multi-institutional study. Catheter Cardiovasc Interv 70(2):276–285CrossRefPubMedGoogle Scholar
  20. 20.
    Magee AG, Brzezinska-Rajszys G, Qureshi SA et al (1999) Stent implantation for aortic coarctation and recoarctation. Heart 82:600–606CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Suarez de Lezo J, Pan M, Romero M et al (1995) Balloon-expandable stent repair of severe coarctation of aorta. Am Heart J 129:1002–1008CrossRefPubMedGoogle Scholar
  22. 22.
    Peters B, Ewert P, Berger F (2009) The role of stents in the treatment of congenital heart disease: current status and future perspectives. Ann Pediatr Cardiol 2:3–23CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Ebeid M (2003) Balloon expandable stents for coarctation of the aorta: review of current status and technical considerations. Images Paediatr Cardiol 5:25–41PubMedPubMedCentralGoogle Scholar
  24. 24.
    Kudumula V, Noonan P, Taliotis D et al (2014) Implantation and preliminary follow-up of the Bard Valeo stent in pulmonary artery stenosis. Catheter Cardiovasc Interv 84:197–203CrossRefPubMedGoogle Scholar
  25. 25.
    Ovaert C, Luciano D, Gaudart J et al (2015) The VALEO(R) vascular stent for cardiovascular lesions in children. EuroIntervention 10:1326–1331CrossRefPubMedGoogle Scholar
  26. 26.
    Kuecherer HF, Just A, Kirchheim H (2000) Evaluation of aortic compliance in humans. Am J Physiol Heart Circ Physiol 278:H1411–H1413PubMedGoogle Scholar
  27. 27.
    Tominaga R, Kambic HE, Emoto H et al (1992) Effects of design geometry of intravascular endoprostheses on stenosis rate in normal rabbits. Am Heart J 123:21–28CrossRefPubMedGoogle Scholar
  28. 28.
    Ing F (2002) Stents: what’s available to the pediatric interventional cardiologist? Catheter Cardiovasc Interv 57:374–386CrossRefPubMedGoogle Scholar
  29. 29.
    Morrow WR, Palmaz JC, Tio FO et al (1993) Re-expansion of balloon-expandable stents after growth. J Am Coll Cardiol 22:2007–2013CrossRefPubMedGoogle Scholar
  30. 30.
    Duke C, Rosenthal E, Qureshi SA (2003) The efficacy and safety of stent redilatation in congenital heart disease. Heart 89:905–912CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Ing FF, Grifka RG, Nihill MR et al (1995) Repeat dilation of intravascular stents in congenital heart defects. Circulation 92:893–897CrossRefPubMedGoogle Scholar
  32. 32.
    Toro-Salazar OH, Steinberger J, Thomas W et al (2002) Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol 89:541–547CrossRefPubMedGoogle Scholar
  33. 33.
    Bratincsak A, Moore JW, Gulker B et al (2015) Breaking the limit: mechanical characterization of overexpanded balloon expandable stents used in congenital heart disease. Congenit Heart Dis 10:51–63CrossRefPubMedGoogle Scholar
  34. 34.
    Canniffe C, Ou P, Walsh K et al (2013) Hypertension after repair of aortic coarctation–a systematic review. Int J Cardiol 167:2456–2461CrossRefPubMedGoogle Scholar
  35. 35.
    Eicken A, Pensl U, Sebening W et al (2006) The fate of systemic blood pressure in patients after effectively stented coarctation. Eur Heart J 27:1100–1105CrossRefPubMedGoogle Scholar
  36. 36.
    Chen SS, Donald AE, Storry C et al (2008) Impact of aortic stenting on peripheral vascular function and daytime systolic blood pressure in adult coarctation. Heart 94:919–924CrossRefPubMedGoogle Scholar
  37. 37.
    Bentham JR, English K, Ballard G et al (2013) Effect of interventional stent treatment of native and recurrent coarctation of aorta on blood pressure. Am J Cardiol 111:731–736CrossRefPubMedGoogle Scholar
  38. 38.
    Veeram Reddy SR, Welch TR, Wang J et al (2015) A novel design biodegradable stent for use in congenital heart disease: mid-term results in rabbit descending aorta. Catheter Cardiovasc Interv 85:629–639CrossRefPubMedGoogle Scholar
  39. 39.
    Alexy RD, Levi DS (2013) Materials and manufacturing technologies available for production of a pediatric bioabsorbable stent. Biomed Res Int 2013:1379–1385. doi: 10.1155/2013/137985 CrossRefGoogle Scholar
  40. 40.
    Chakrabarti S, Kenny D, Morgan G et al (2010) Balloon expandable stent implantation for native and recurrent coarctation of the aorta- prospective computed tomography assessment of stent integrity, aneurysm formation and stenosis relief. Heart 96:1212–1216CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Sok-Leng Kang
    • 1
  • Andrew Tometzki
    • 1
  • Demetris Taliotis
    • 1
  • Robin Martin
    • 1
  1. 1.Bristol Royal Hospital for ChildrenUniversity Hospitals Bristol NHS Foundation TrustBristolUK

Personalised recommendations