Stenting of the Arterial Duct in Newborns with Duct-dependent Pulmonary Circulation

Giuseppe Santoro ^1*, Gianpiero Gaio ¹, Maria Teresa Palladino ¹, Carola Iacono ¹, Marianna Carrozza ¹, Raffaella Esposito ¹, Maria Giovanna Russo ¹, Giuseppe Caianiello ² and Raffaele Calabrò ¹

¹ Cardiology, "Monaldi" Hospital, II University of Naples, Italy
² Pediatric Cardiac Surgery, "Monaldi" Hospital, II University of Naples, Italy

^* To whom correspondence should be addressed. E-mail: santoropino{at}tin.it.

Accepted 19 June 2007

Abstract

Objective To evaluate the feasibility and the results of stenting of the arterial duct in newborns with duct-dependent pulmonary circulation using low-profile and high-flexibility pre-mounted coronary stents.

Deaign Prospective interventional and clinical follow-up study.

Setting Tertiary referral centre.

Patient Population Between April 2003 and December 2006, 26 neonates [age 15.2(19.9) days, weight 3.3(0.8) kgs] underwent attempts at stenting of the arterial duct.

Main Outcome Measures Procedural success and complication rates. Early and mid-term follow-up results.

Results The procedure was successfully completed in 24/26 (92.3%) of cases. Minor complications occurred in 2/26 (7.7%) of cases. No mortality occurred. After stenting, the ductal diameter increased from 1.2(1.0) to 3.1(0.4) mm (p<0.0001) and the percutaneous O2 saturation increased from 70(14) to 86(10)% (p<0.00001), respectively. Over a mid-term follow-up, 2/24 patients (8.3%) needed a systemic-to-pulmonary artery shunt because of inadequate ductal flow and 4/24 patients (16.7%) underwent stent re-dilatation after 6.0(4.4) months, but prior to corrective surgery. Cardiac catheterization prior to corrective surgery in 9 patients showed an increase of the Nakata index from 112(49) to 226(108) mm/mm2 (p<0.001), without any left-to-right unbalance of the pulmonary artery size. In the subset of 11 patients who improved without needing an additional source of pulmonary blood supply, the stented arterial duct closed uneventfully in 45.5% of cases after 4.0(2.2) months.

Conclusions Stenting of the arterial duct is a feasible, safe and effective palliation in newborns with duct-dependent pulmonary circulation, supporting the spontaneous improvement process or promoting significant and balanced pulmonary artery growth for subsequent corrective surgery.

Keywords: Cardiac catheterization, Congenital heart disease, Cyanosis, Patent arterial duct, Stent

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