A severe obstruction in the aorta of a 2.2 pound premature infant was eliminated through the implantation of a modified coronary stent in a unique procedure performed at MUSC on Nov. 20.

The aorta is the main artery of the body and supplies the body with blood. Blockage of this vessel is known as critical aortic coarctation. It is believed that this is the first time this procedure has ever been performed on a premature newborn.

The baby is Trevonn Wilson of Columbia. Wolfgang A.K. Radtke, M.D., the MUSC pediatric cardiologist who implanted the stent using a heart catheter, said the procedure was intended to allow Trevonn to grow so that a surgical correction could later be performed. The stent is a small, slotted, stainless steel tube mounted on a balloon catheter and positioned at the site of the obstruction. Radtke worked closely with Andre Hebra, M.D., a pediatric surgeon. Normally a stent is introduced to the blocked heart vessel by inserting a catheter through a blood vessel in the leg or groin. But because of the patient’s size the catheter was inserted from the neck where Hebra exposed the left carotid artery, through which the catheter introduced the stent to the blocked aorta. At the end of the procedure, Hebra repaired the vessel.

In addition to the severe obstruction of the aorta, Trevonn also has a hole between the pumping chambers of the heart and a narrowing underneath the valve connecting to the aorta. The ductus arteriosus, a natural connection between the main lung artery and the lower aorta, that normally closes up after birth was kept open with medication prior to the procedure. This prevented the severe obstruction of the upper aorta to pinch off all blood flow to the lower body. However, although already five weeks old, Trevonn had gained a little more than four ounces since birth and was increasingly suffering from heart failure, flooding of the lungs and underweight.

“At this age and weight, surgical correction was impossible,” said Radtke, “but at the same time, it was clear that Trevonn would further deteriorate if the obstruction was not relieved.”

Therefore, neonatologists, cardiac surgeons and pediatric cardiologists decided to perform the catheter procedure that had never been done before under these circumstances. “Trevonn is doing well and already shows signs of improvement,” said Radtke. “Although the procedure was successful, there are still many other obstacles to recovery.”