專題討論2:目前在介入放射和腔內血管治療的進展和技術
Current Issues and New Techniques in Interventional Radiology and Endovascular Therapy

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S2-10
Stenting in congenital heart disease
陳俊安Chun-An Chen, MD. PhD
Department of Cardiology, National Taiwan University Children’s Hospital


  Vascular stenosis, either congenital or postoperative, is a common indication for transcatheter intervention in congenital heart disease. Since the first report of transcatheter balloon dilation of pulmonary stenosis in 1953, balloon angioplasty has been widely used in various locations with vascular stenosis. However, elastic recoil of the vessel and intimal dissection are major limitations of balloon angioplasty. In such circumstances, “stenting” is a reasonable alternative to surgical intervention. Stents could provide effective and predictable relief of obstruction and prevent elastic recoil. Numerous structural lesions in congenital heart disease could be treated with stenting, including pulmonary artery stenosis, coarctation of the aorta, ductus arteriosus, right ventricle-to-pulmonary artery conduit stenosis, surgical shunt stenosis, stenotic aortopumonary collateral vessels, and cavopulmonary conduit stenosis. Despite of tremendous technical improvement in stent design over the past few decades, the failure of adaptation to somatic growth and the size of delivery system remained major drawbacks of stenting, particularly in infants and children with congenital heart disease. In-stent stenosis is another concern. Furthermore, clinical application of most stents currently used for treating congenital heart disease is actually “off-label” usage, and none officially approved by the FDA. Nonetheless, stenting for congenital heart disease has been accepted as the standard of care in most pediatric cardiac center worldwide. In this talk, I would like to briefly introduce this intervention, review its advantages and disadvantages, and share our institutional experience.