Johnson and Johnson™ Palmaz™ intravascular stents (Johnson and Johnson Interventional Systems, Sommerville, NJ) have been used to treat branch pulmonary artery stenosis and right ventricular conduit obstruction since late 1989 . The P_ _8 series stents that can be dilated to adult diameters, now are accepted as the standard therapy for pulmonary branch stenosis. The stents and balloons used to deliver them have always been "hand-me-downs" from the adult vascular arena. As the authors point out, until recently, the only stents available in the United States were very rigid and have very sharp ends making it difficult for them to traverse tight curves within the heart. The only stents applicable for the central pulmonary arteries (the P_ _8 series) required a large delivery system that was not suitable for infants. Although the smaller stents (P_ _4 series) could be delivered through smaller systems, they were never applicable for the central pulmonary arteries. Remarkable results were achieved with the larger series stents, yet they were never ideally suited for the complicated anatomy of congenital heart disease. At the same time, it never was in the "business interests" of the manufacturers to even recognize, much less modify or develop stents specifically for pediatric use.
The Palmaz Corinthian™ stents (Cordis Endovascular, Johnson and Johnson, Warren, NJ) described in this article were designed again for adult interventional use and still do not fulfill the needs for central pulmonary vessels. They do represent a step in the right direction. They have a more "open cell" design, rounded ends of the cells, hinge points between cells and can be delivered through the same-sized, small delivery system as the