Purpose Patent Ductal Arteriosus (PDA) stenting in the setting of pre-existing branch pulmonary artery (PA) stenosis is controversial. Current American Heart Association guidance is to avoid ductal stenting in this setting.
During fellowship training I spent time at an institution which has undergone a learning curve in complex ductal stenting. CT imaging enabled better understanding of complex ducts, aided patient selection, planning and consideration of access routes.
Methods Prospective review of patients (<3 months, >2.5 kg) undergoing PDA stenting with ductus related branch PA stenosis between Jan 2014 – Dec 2015. The growth of the jailed stenotic PA branch with the contralateral PA was compared angiographically 6–12 months later.
Results 46 patients underwent ductal stenting. 37% had ToF-PA (17/46). There was no in-hospital mortality and 2 early deaths occurred.
4 patients required early modified Blalock Taussig Shunt (mBTS) and were further excluded.
The unaffected PA showed good growth (mean Z score from −0.6 to +2.2). The jailed PA also showed proportionate growth (mean Z score from −1.4 to +1.1) in 93% (37/40). 3 patients showed poor PA growth (2 underwent restenting, 1 mBTS to affected side).
Conclusion In an era where neonatal mBTS continues to have significant morbidity and mortality, we feel that ductal stenting in complex PDA’s with pre-existing PA stenosis is a feasible alternative. The stenosed, jailed PA still has potential for proportionate growth. Patient selection and close follow up is vital. Stent removal with surgical repair within 1 year of age is our current recommendation.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.