A Case Report: the Handmade Covered Stent Insertion in Pediatric Patient with Recurrent Congenital Pulmonary Vein Stenosis

Kentaro Hotoda, Shigeki Yoshiba, Ryusuke Hosoda, Keisuke Ozawa, Mika Iwazaki, Ayumu Masuoka, Toshiyuki Katogi, Takaaki Suzuki

Saitama International Medical Center, Saitama Medical University, Saitama, Japan

Date, time and location: 2018.05.25 13:30, Press Hall, 2F

Abstract

Congenital pulmonary vein stenosis (CPVS) is rare and lethal, especially if restenosis is occurred. Reported restenosis and mortality rate after treatment of CPVS remain high. This report shows how to make the handmade covered stent and to insert to pinholes of PVs. The case, 2.0-year-old boy with weight of 7kg, had severe recurrent PVS after two release of PVS with sutureless technique and intimal resection. CT scan showed pinholes of the left upper/lower and the right lower PVs, and closed right upper PV. We planned the insertion of the handmade covered stent. The optimal sized covered stent was not available in Japan, so we needed to make the covered stent with Express SD vascular stent (open cell type bare metal stent) of 6mm in diameter by 15mm in length and GoreTex patch of 0.1mm. The strip of the patch was manually wrapped around and loosely fixed on the stent. This enough length of the patch and loose fixation made the stent re-expandable. The heart was arrested and the atrial septectomy was made to identify three pinholes of PVs. The handmade covered stents were directly placed in the left upper and lower PVs. The intimal resection was made in right lower PV, because it was too close to the bifurcation of distal PV to place the stent of 15mm in length. The patient was discharged from the hospital. On postoperative month 7, CT scan and echocardiogram showed no PVS.