Infant is first in region to get innovative stent that grows with her into adulthood
By Tricia Tomiyoshi
(SACRAMENTO)
A baby treated at UC Davis Health is the first in Northern California to receive a new stent designed for infants that grows as the patient grows. It can start at 6 millimeters in diameter and expand to 24 millimeters – large enough for an adult.
The Minima Stent System, designed for narrowing or blockage of arteries specifically in infants, is the only Federal Drug Administration-approved system of its kind. It was exactly the right device for Lillian Hodgkin when she needed it most.
Lillian Hodgkin was born eight weeks premature, with DiGeorge syndrome, also known as 22q11.2 deletion syndrome, a genetic condition caused by a missing piece of chromosome 22. Patients like Lillian often have Type B interrupted aortic arch, a congenital heart condition in which a portion of the aortic arch is missing and would need to be reconnected.
A medical illustration of Lillian's heart anatomy
But Lillian’s heart was even more unusual. “In my career of 33 years, I have never seen a heart anatomy like hers,” said Frank Ing, interventional cardiologist, chief of pediatric cardiology and co-director of the UC Davis Pediatric Heart Center.
Lillian had an aberrant left subclavian artery (abnormal distal take off of the artery toward the left arm) and a bilateral patent ductus arteri. In her case the right PDA was connecting the interrupted descending aorta to the right pulmonary artery, while the left PDA coming off the ascending aorta and connecting to the left pulmonary artery.
“In essence, it was the right-sided PDA that provided essential flow to the lower half of her body,” Ing said.
The best approach for the best chance at life
The UC Davis pediatric heart team spent many nights, even after hours, discussing how best to proceed to ensure that Lillian would have the very best chance at life.
Lillian, who was hospitalized in the UC Davis Neonatal Intensive Care Unit, needed open heart surgery to repair her heart. But because she was so small and sick, the risks were high. The team decided to wait until she was at least 5 kilograms, or 11 pounds, in size and at least past her original due date.
In the meantime, Ing placed flow restrictors (a device to control or limit her pulmonary blood flow) in the Cardiac Catheterization Lab. He had to position the flow restrictors so that they didn’t block the right PDA flow to the descending aorta.
The day after Lillian reached her original due date, pediatric cardiothoracic surgeon Timothy Pirolli repaired her interrupted aortic arch, a complicated surgery which restored her blood flow.
Amanda and Lillian with Frank Ing at an appointment last month.
The surgery was a resounding success. But in one of her follow-up echocardiograms, her care team noticed a narrowing of the aorta.
A stent to last through childhood
The solution turned out to be the innovative new Minima Stent System. It can be inserted with a tiny delivery system and further expand to accommodate her natural growth into adulthood.
The day after the procedure, Jake and Amanda were able to take Lillian back home to Placerville. The difference in Lillian has been like night and day, her parents said.
“Since the procedure, she has so much energy, and is more lively. She has been smiling nonstop,” Jake said.
The UC Davis team will continue to monitor her and will expand the stent as she grows. No additional heart surgeries are needed.
“This team at UC Davis has been so amazing. This was probably one of the scariest things that has ever happened to us, but the UC Davis team has done amazing things for Lillian,” Amanda said.
