title: Delivering stents in congenital heart disease using the double-wire technique: technical considerations.
abstract: OBJECTIVE
  To evaluate the use of a double-wire technique to deliver stents.
  
  
  BACKGROUND
  Placement of a stent in lesions close to bifurcations or without an anatomic obstruction can be problematic.
  
  
  METHODS
  Stents were implanted in 12 patients between August 2010 and August 2012. Indications were complex anatomic obstruction in nine, external compression of pulmonary veins in two, and exclusion of an aortic aneurysm in one patient.
  
  
  RESULTS
  Median age and body weight of the group were 11.6 years (range: 1.6-34.8) and 36 kg (range: 10-78), respectively. All stents were delivered safely and the patency of all side vessels was maintained; the distal end of the stent was flared to a median ratio of 1.4 (range: 1.2-1.8). The clinical objective was met in all patients: in lesions with stenosis, diameter increased from 5.9 mm (range: 1-13) to 9.9 mm (range: 8-17) [P < 0.01; 95% confidence interval (CI): 2.0-7.2]; oxygen saturations improved in the 2 patients after relief of the external pulmonary venous compression and in another an aortic aneurysm was excluded. One patient developed a hemothorax and one required blood transfusion for bleeding from the valve of the sheath.
  
  
  CONCLUSIONS
  The double-wire stenting technique is effective to accurately deliver and anchor stents into lesions close to side branches and bifurcations. Side branch patency is maintained; the clinical objective (gradient relief, aneurysm exclusion, relief of external compression) can safely be reached. Technique and balloon selection should be based on the underlying anatomical substrate.
authors.affiliation: Department of Paediatric Cardiology, University Hospitals Leuven, Belgium; Department of Paediatric Cardiology, University of the Free State, South Africa.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Brown
authors.forename: Bjorn
authors.initials: B
authors.lastname: Cools
authors.forename: Derize E
authors.initials: DE
authors.lastname: Boshoff
authors.forename: Nazan
authors.initials: N
authors.lastname: Ozbarlas
authors.forename: Ruth
authors.initials: R
authors.lastname: Heying
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
authors.forename: Daniël
authors.initials: D
authors.lastname: Buys
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
mesh_terms: D000293:Adolescent; D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult
keywords: congenital cardiology; double wire; interventional catheterization; stent