RT Journal Article
SR Electronic
T1 5 Outcomes of ductal stenting with pre-existing branch pulmonary artery stenosis – revisiting the american heart association guidelines
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP A2
OP A3
DO 10.1136/heartjnl-2017-BCCA.5
VO 104
IS Suppl 2
A1 Rizwan Rehman
A1 Marhisham Mood
A1 Hasri Samion
A1 Mazeni Alwi
YR 2018
UL http://heart.bmj.com/content/104/Suppl_2/A2.2.abstract
AB 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.