Cor Vasa 2021, 63(1):53-57 | DOI: 10.33678/cor.2020.029

Percutaneous coronary interventions in children with structurally normal hearts. Is there any place for stenting?

Jaouadi Abdelaziz, Jamel Ahmad, Abdallah Maroua, Messaoudi Yosra, Ibn Ezzine Bilel, Ben Halima Nejeh

Cardiology Department, Ibn El Jazzar University Hospital, Kairouan, Tunisia 3100

Introduction: Acute coronary syndromes (ACS) are far more common in adulthood than in childhood, congenitally related coronary insufficiency occupies a convenient part (especially after surgical repair, i.e. TGA arterial switch) but ACS in structurally normal hearts are more common related to systemic disorders and/or loco-regional epicardial coronary anomalies. Although, percutaneous coronary angioplasty (PCA) is paramount in adults who have had an acute coronary syndrome especially with stent implantation reducing the consequent mortality, it's not a common option in children and extremely rare in infants considering the complications that can be incurred.

Patients and methods: We aim to report three clinical cases of structurally normal hearts in patients aged less than 18 years in this study who experienced an acute coronary syndrome and underwent a percutaneous coronary angioplasty Aim of the case presentations: We aim to study through this work the challenging courses of the diagnosis and the management of ACS in this specific population and the efficacy of coronary angioplasty with its suspected complication as well as to discuss the place of stenting as therapeutic option.

Results: Three patients aged respectively 4, 10, and 12 years underwent percutaneous coronary intervention after an acute coronary syndrome with ST segment elevation related to Kawasaki disease in one case and to familial hypercholesterolemia in the other cases.

Keywords: Acute coronary syndrome, Angioplasty, Childhood, Coronary angiography showed a significant stenosis in the left coronary arteries in all cases., Successful angioplasty with stent implantation was achieved in two cases and a balloon angioplasty was undergone in one case., The follow up of these patients did not show any recurrences or complications related to the PCA., Conclusion: Coronary angioplasty can be a viable strategy for infants and children with blocked arteries or a left ventricle dysfunction, alternative to surgical revascularization and heart transplantation when they are older, but because of the increased risk of PCA and the difficulty of heart catheterization, it remains a controversial issue.

Received: August 10, 2019; Revised: April 21, 2020; Accepted: April 24, 2020; Published: February 25, 2021  Show citation