Redilatable Coronary Stent in a 1-Year-Old Boy after Cardiac Arrest due to Left Main Stenosis after Arterial Switch with Intramural Course of the LCA

Objectives: Coronary stents are rarely implanted in childhood. First, they are difficult to implant in small children; second, small stents tend to occlude despite sufficient anticoagulation and long-term patency is hindered by the lack of growth potential. A 1-year 2-month-old boy was admitted to our intensive care unit after cardiopulmonary resuscitation. As a newborn, he had had an arterial switch operation for simple transposition of the great arteries. Surgery was complicated due to an intramural course of the left main coronary artery leading to a patch enlargement of the ostium. At the age of 8 months, the boy was asymptomatic with normal left ventricular (LV) function, no mitral regurgitation, and without regional wall motion abnormalities. Control angiography showed an ostial stenosis but with good collateral flow from the right coronary artery. As there were no signs of regional ischemia, we decided not to intervene. Six months after the catheterization, the boy suffered cardiac arrest due to ventricular fibrillation at home. After successful resuscitation, there was still normal LV function and no regional wall motion abnormalities. Cardiac troponin was only mildly elevated. He recovered from the cardiac arrest with almost no neurological sequels. Interventional catheterization was performed and the left main coronary artery was balloon dilated and stented with a 2.25-mm drug-eluting stent (XIENCE Sierra, Fa. Abbott) and over dilated to 2.58 mm. No clinical problems arose under dual platelet inhibition.

Comments: Despite clinical well-being, left main coronary stenosis can cause severe cardiac problems. Coronary stents can be implanted in small children to relief significant stenoses. Due to the possibility of redilation of the XIENCE Sierra stent up to a diameter of 3.5 mm, we do expect sufficient “growth potential” of the stent until adult age.