ABSTRACT
Introduction Since 1990, transcatheter implantation of intravascular stents has been extensively described as an effective form of therapy for a variety of acquired and congenital vascular stenoses.1-7 Congenital lesions treated by stent placement include central and branch pulmonary artery stenosis, native and recurrent coarctation of the aorta, a variety of venous stenoses, intra-or extracardiac baffle obstructions, and conduit narrowing. More recently, stents and covered stents have been utilized as a means of creating or maintaining new vascular channels, such as transcatheter Fontan baffle placement or long term maintenance of ductal arteriosus patency.8-12 Although the effectiveness of stent therapy is well accepted, the technical demands of implantation have at times limited the applicability of these devices, particularly in small, critically ill children. While improvements in delivery technique, balloon, stent, and sheath technology have made percutaneous stent implantation a more accomplishable procedure,13-15 there are numerous clinical scenarios where intra-operative stent implantation may be preferable. In this chapter we will discuss the techniques utilized for intra-operative implantation of stents in the pulmonary arteries and aorta.
