• Patent ductus arteriosus stenting as a staged palliation in congenital heart defects with duct-dependent pulmonary blood flow
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Patent ductus arteriosus stenting as a staged palliation in congenital heart defects with duct-dependent pulmonary blood flow

SOVREMENNAYA PEDIATRIYA.2014.6(62):74-79;doi 10.15574/SP.2014.62.74

Patent ductus arteriosus stenting as a staged palliation in congenital heart defects with duct-dependent pulmonary blood flow

Maksymenko A. V., Kuzmenko Y. L., Motrechko O. O., Bohuta L. Y., Boyko O. P., Dovgaljuk A. A. 
Ukrainian Children`s Cardiac Center, Kyiv, Ukraine 
Shupyk’s National medical academy of postgraduate education

Background. We aimed to report our initial experience of patent arterial duct stenting, immediate and long-term results, to describe technique of this intervention, to show analysis of complications and potential ways of their prevention.

Methods. From July 2009 to October 2013 seven patients underwent patent ductus arteriosus stenting. Five patients had Tetralogy of Fallot with non-confluent pulmonary artery branches, two — pulmonary atresia. Mean age of the patients was 175±222 days (from 8 to 390 days), mean weight — 5.8±3.8 kg (from 2.9 to 11.0 kg). Four out of seven patients had right-aortic arch. Three out of seven patients underwent balloon angioplasty of patent ductus arteriosus 2 days — 1 month prior to stenting. Stenting was carried out through the femoral vein in 3 patients and retrogradely through the femoral artery in 4 patients utilizing coronary stent-systems.

Results. Stenting of the patent ductus arteriosus and pulmonary valvuloplasty provided increase of pulmonary blood flow and increase in saturation from an average of 70.4±8.6 to 91±7%. There were no deaths in the early postoperative period and during the entire follow-up. Early postoperative complications were observed in 2 patients (28.7%). Six patients experienced significant increase in pulmonary artery branches size. Mean Nakata index increased from 151.2 mm2/m2 to 285.8 mm2/m2 and total neopulmonary index (n=1) increased from 84 mm2/m2 to 185 mm2/m2. Three patients (42.8%) required redo palliations: re-stenting of the arterial duct (n=2) and, later, placement of systemic-to-pulmonary shunt in one of them (n=1); balloon stentoplasty (n=1). Four out of seven patients received complete repairs of cyanotic congenital heart disease with no additional palliations.

Conclusions. Stenting of the patent arterial duct is a new and effective palliative approach for restoration and maintenance of pulmonary blood flow in children with cyanotic congenital heart disease.

Key words: congenital heart disease, palliation, stenting, interventional cardiology.

1. Moszuraa T, Zubrzyckac M, Michalaka K et al. 2010. Acute and late obstruction of a modified Blalock-Taussig shunt: a two-center experience indifferent catheter-based methods of treatment. Interactive Cardio Vascular and Thoracic Surgery: 727—731. http://dx.doi.org/10.1510/icvts.2009.219741; PMid:20139195

2. Alwi M. 2012. Stenting the patent ductus arteriosus in duct-dependent pulmonary circulation: techniques, complicationsand follow-up issues. Future Cardiol. 8(2): 237—50. http://dx.doi.org/10.2217/fca.12.4; PMid:22413983

3. Vida VL, Speggiorin S, Maschietto N et al. 2010. Cardiac operations after patent ductus arteriosus stentingin duct-dependent pulmonary circulation. Ann Thorac Surg. 90(2): 605—9. http://dx.doi.org/10.1016/j.athoracsur.2010.04.007; PMid:20667358

4. Kogon B, Villari C, Shah N et al. 2007. Occlusion of the modified Blalock-Taussig shunt: unique methods of treatment and review of catheter-based intervention. Congenit Heart Dis. 2: 185—190. http://dx.doi.org/10.1111/j.1747-0803.2007.00095.x; PMid:18377463

5. Matter M, Almarsafawey H, Hafez M et al. 2013. Patent ductus arteriosus stenting in complex congenital heart disease: early and midterm results for a single-center experience at children hospital, Mansoura, Egypt. PediatrCardiol. 34(5): 1100—4. http://dx.doi.org/10.1007/s00246-012-0608-x

6. Amoozgar H, Cheriki S, Borzoee M et al. 2012. Short-term result of ductus arteriosus stent implantation compared with surgically created shunts. Pediatr Cardiol. 33(8): 1288—94. http://dx.doi.org/10.1007/s00246-012-0304-x; PMid:22447384

7. Schranz D, Michel-Behnke I, Heyer R et al. 2010. Stent implantation of the arterial duct in newborns with a truly duct-dependent pulmonary circulation: a single-center experience with emphasison aspects of the interventional technique. J Interv Cardiol. 23: 581—8. http://dx.doi.org/10.1111/j.1540-8183.2010.00576.x; PMid:20642476

8. Santoro G, Gaio G, Palladino MT et al. 2008. Stenting of the arterial duct in newborns with duct-dependent pulmonary circulation. Heart. 94(7): 925—929. http://dx.doi.org/10.1136/hrt.2007.123000; PMid:17664187

9. Schranz D, InHijazi ZM, Feldman T et al. 2009. Stenting the arterial duct. Complications during percutaneous interventions for congenital and structural heart diseas. Informa Healthcare UK Ltd. London: 131—144.