• 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.

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