Midterm Outcome of Stent Dilatation of Patent Ductus Arteriosus in Ductal-dependent Pulmonary Circulation

Objective. We sought to assess the outcome of transcatheter ductus arteriosus stenting in newborns with ductal-dependent pulmonary circulation.

Background. Better results of ductal stenting have been reported using stents with better scaffolding and ensuring stenting of the entire length of the ductus arteriosus.

Methods. Twenty-one patients with ductal-dependent pulmonary circulation were brought to the catheterization laboratory for ductal stenting. Five patients did not qualify because of a complex tortuous ductus arteriosus or branch pulmonary artery stenosis. Stent implantation was successful in 14 patients. The duct was accessed with a 0.014-inch guidewire. A low profile premounted coronary stent was implanted in the duct without using a long delivery sheath. Attempts were made to cover the entire length of the ductus arteriosus.

Results. The mean age of the patients at the time of stent implantation was 24 ± 17.5 days. The mean body weight was 2.9 ± 0.35 kg. The ductus was mildly tortuous in four, moderately tortuous in four, conical in four, and vertical in four patients. Ductal stenting was successful in 14 patients. The mean ductal diameter was 3.9 ± 0.5 mm. The mean diameter and the length of the stent implanted were 3.9 ± 0.72 and 15.4 ± 3.16 mm, respectively. Mean fluoroscopy and procedure times were 22.16 ± 12.5 and 107.9 ± 34.5 minutes, respectively. Out of the 14 successful stent implantations, the ductus arteriosus was not completely covered with the stent in five patients at the time of primary procedure, four of them required re-stenting for significant desaturation. One of these patients died despite successful re-stenting. Another patient died due to aspiration pneumonia. Of the 12 survivors, five underwent Glenn shunt (two deaths related to pulmonary hypertension), two underwent biventricular repair, one patient was lost to follow-up, and the remaining four are doing well with a mean oxygen saturation of 85% at a mean follow-up of 13 ± 6 months.

Conclusion. Stenting of ductus arteriosus, including moderately tortuous ducts, is a safe palliation for patients with ductal-dependent pulmonary circulation. Incomplete stenting of the duct invariably results in ductal stenosis and compromised pulmonary flow.