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Neonates with duct-dependent pulmonary circulation are traditionally treated with a surgical aortopulmonary shunt—in effect, a synthetic duct which will not close of its own accord. It seems eminently logical to try to keep the duct itself open rather than to resort to a surgical equivalent. While prostaglandins are almost always highly effective at maintaining duct patency medically in the short term, they become less reliable and have more side effects if given long term. Maintaining duct patency by stent implantation at cardiac catheterisation was first described in the early 1990s.1 Although guidewires and operator skills have not changed appreciably in the past 15 years, stent and balloon technology are much more advanced, and one might hope that the improvements in equipment would have improved the results of this theoretically attractive treatment. In this issue of Heart Santoro and colleagues report their recent experience of a case series of ductal stenting2 with a median follow-up of 12 months, prompting a re-evaluation of the place of this procedure in modern practice (see page 925).
In the absence of a controlled trial (which would be difficult to design and is most unlikely to happen) we are left with historical data …