sirolimus and Aortic-Coarctation

With a prevalence of 2.6-4.5 %, infantile haemangiomas (IH) represent the most common tumour of infancy. While the majority of IH does not require therapy and regresses spontaneously, about 10 % of IH exhibit complications such as obstruction, ulceration or disfigurement. With the advent of oral propranolol, many conventional treatment options have become obsolete. This paper summarizes current recommendations for management of complicated IH. These recommendations have been written by an expert group after a consensus process including bibliographic review, several drafts of synthesis, meetings with quantitative voting system and redaction of an approved final manuscript.. Oral propranolol is the first-line agent for the treatment of complicated IH.. • Infantile haemangiomas (IH) are the most common tumours of infancy. Within a very short period after its discovery and long before the publication of randomized controlled trials, propranolol has become the number one agent for the treatment of complicated IH. What is New: • We report IH treatment recommendations of an international, interdisciplinary team of experts, based on an up-to-date review of the literature.

Topics: Administration, Topical; Adrenergic beta-Antagonists; Aortic Coarctation; Cryotherapy; Diagnosis, Differential; Esthetics; Eye Abnormalities; Glucocorticoids; Hemangioma; Humans; Immunosuppressive Agents; Infant; Laser Therapy; Neurocutaneous Syndromes; Phototherapy; Propranolol; Risk Factors; Sirolimus; Vascular Neoplasms; Watchful Waiting

Patients with Williams syndrome often present with abnormalities of the vascular wall of the aorta and/or the pulmonary artery. Surgery may result in restenosis of the affected vessel. Herein, we report a case of an infant with multiple recurrences of aortic coarctation successfully treated with Zotarolimus drug-eluting stent.

Topics: Aortic Coarctation; Computed Tomography Angiography; Drug-Eluting Stents; Female; Humans; Infant, Newborn; Magnetic Resonance Imaging; Percutaneous Coronary Intervention; Recurrence; Sirolimus; Treatment Outcome; Williams Syndrome

We, herein, report the first use of a Magmaris® magnesium-based vascular scaffold for native aortic coarctation in a 1,980 g infant with multiple malformations. Due to the low body weight, complex illness, and clinical instability, it was decided to delay surgical correction. After insufficient results had been obtained by balloon angioplasty, Magmaris® implantation was chosen to bridge the patient to surgery by stabilizing left ventricular function and to allow for sufficient growth. Due to significant early stent restenosis and complete loss of radial force, the patient required balloon reangioplasty only 21 days after Magmaris® implantation and early surgical correction. In addition, high systemic sirolimus levels were detected 48 hr after the intervention (5 ng/mL). Although the bioresorbable scaffold was successfully used as a short-term bridge-to-surgery in our case, due to significant early stent failure (loss of radial force), this approach does not seem promising for long-term bridging of infants with aortic coarctation. In addition, the consequences of sirolimus-induced systemic immunosuppression may further limit the applicability of Magmaris® scaffolds in infants with congenital heart disease.

Topics: Absorbable Implants; Aortic Coarctation; Birth Weight; Cardiovascular Agents; Endovascular Procedures; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Magnesium; Prosthesis Design; Prosthesis Failure; Recurrence; Retreatment; Sirolimus; Stents; Treatment Outcome