Outcome of Ductus Arteriosus Stenting Including Vertical Tubular and Convoluted Tortuous Ducts with Emphasis on Technical Considerations

Overview

Journal Egypt Heart J

Publisher Springer

Specialty Cardiology & Vascular Diseases

Date 2021 Sep 20

PMID 34542737

Citations 6

Authors

Saud Bahaidarah

Jameel Al-Ata

Naif Alkhushi

Ahmad Azhar

Zaher Zaher

Bayan Alnahdi

Mohamed Abdelsalam

Ahmed Elakaby

Ahmed Dohain

Gaser Abdelmohsen

Affiliations

Soon will be listed here.

Abstract

Background: Ductal stenting is the preferred method of securing adequate pulmonary blood flow in patients with duct-dependent pulmonary circulation. The main limitation in most centers is the difficult vertical tubular or convoluted ducts that represent real challenges to interventional pediatric cardiologists. We present our experience in patent ductus arteriosus (PDA) stenting with some technical tips to overcome difficulties, especially in stenting tortuous or long tubular ducts. This study was conducted on all patients with cyanotic congenital heart disease who underwent PDA stenting between January 2011 and December 2018.

Results: We attempted to stent the PDA in 43 patients, with a success rate of 93% (40 patients) and only one procedural mortality. There was also one stent migration that needed to be treated with urgent surgery. Three-fourths of the patients had difficult ductal morphology and origin. One stent was used to cover the PDA in 27 patients (62.8%), two stents were used in 13 (30.2%), and three stents were used in 2 patients (4.6%). In-stent stenosis rate was 12.5% (5 patients) and the development of progressive left pulmonary artery stenosis was seen in two patients (5%). Pulmonary artery growth was adequate in all patients.

Conclusions: PDA stenting is an effective method of palliation for patients with duct-dependent pulmonary circulation. It has low morbidity and mortality rates. Stenting difficult ducts have become more feasible with evolving materials and techniques.

Citing Articles

Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review.

Bauser-Heaton H, Price K, Weber R, El-Said H J Soc Cardiovasc Angiogr Interv. 2024; 1(6):100392.

PMID: 39132356 PMC: 11308046. DOI: 10.1016/j.jscai.2022.100392.

Erratum: Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review.

Bauser-Heaton H, Price K, Weber R, El-Said H J Soc Cardiovasc Angiogr Interv. 2024; 2(4):101052.

PMID: 39131650 PMC: 11307754. DOI: 10.1016/j.jscai.2023.101052.

The effectiveness of the flip technique in vertical ductal stenting.

Aldudak B, Geter S, Murat M Turk Gogus Kalp Damar Cerrahisi Derg. 2024; 32(1):9-16.

PMID: 38545363 PMC: 10964295. DOI: 10.5606/tgkdc.dergisi.2024.25813.

Three-dimensional/four-dimensional spatiotemporal image correlation morphology of the ductus arteriosus in fetuses with pulmonary atresia undergoing neonatal ductal stenting.

Karapurkar S, Gurav A, Sudhakar A, Sasikumar N, Kumar R, Vaidyanathan B Ann Pediatr Cardiol. 2024; 16(4):233-241.

PMID: 38343499 PMC: 10856608. DOI: 10.4103/apc.apc_95_23.

Management of ductal spasm in a neonate with pulmonary atresia and an intact ventricular septum during cardiac catheterization: A case report.

Zhang X, Zhang N, Song H, Ren Y World J Clin Cases. 2022; 10(35):13015-13021.

PMID: 36568995 PMC: 9782928. DOI: 10.12998/wjcc.v10.i35.13015.

References

Alwi M . Stenting the ductus arteriosus: Case selection, technique and possible complications. Ann Pediatr Cardiol. 2010; 1(1):38-45. PMC: 2840730. DOI: 10.4103/0974-2069.41054. View

Bentham J, Zava N, Harrison W, Shauq A, Kalantre A, Derrick G . Duct Stenting Versus Modified Blalock-Taussig Shunt in Neonates With Duct-Dependent Pulmonary Blood Flow: Associations With Clinical Outcomes in a Multicenter National Study. Circulation. 2017; 137(6):581-588. DOI: 10.1161/CIRCULATIONAHA.117.028972. View

Hussain A, Al-Zharani S, Muhammed A, Al-Ata J, Galal O . Midterm outcome of stent dilatation of patent ductus arteriosus in ductal-dependent pulmonary circulation. Congenit Heart Dis. 2008; 3(4):241-9. DOI: 10.1111/j.1747-0803.2008.00197.x. View

Santoro G, Gaio G, Palladino M, Iacono C, Carrozza M, Esposito R . Stenting of the arterial duct in newborns with duct-dependent pulmonary circulation. Heart. 2007; 94(7):925-9. DOI: 10.1136/hrt.2007.123000. View

Baho H, Deraz S, Abouzeid H, Al-Ata J, Kouatli A . Stent protrusion in palliative congenital heart disease interventions: does it cause any harm?. J Invasive Cardiol. 2013; 25(9):460-3. View

Amoozgar H, Cheriki S, Borzoee M, Ajami G, Soltani M, Ahmadipour M . Short-term result of ductus arteriosus stent implantation compared with surgically created shunts. Pediatr Cardiol. 2012; 33(8):1288-94. DOI: 10.1007/s00246-012-0304-x. View

Glatz A, Petit C, Goldstein B, Kelleman M, McCracken C, McDonnell A . Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-Dependent Pulmonary Blood Flow: Insights From the Congenital Catheterization Research Collaborative. Circulation. 2017; 137(6):589-601. DOI: 10.1161/CIRCULATIONAHA.117.029987. View

Alwi M, Choo K, Abdul Latiff H, Kandavello G, Samion H, Mulyadi M . Initial results and medium-term follow-up of stent implantation of patent ductus arteriosus in duct-dependent pulmonary circulation. J Am Coll Cardiol. 2004; 44(2):438-45. DOI: 10.1016/j.jacc.2004.03.066. View

Lee K, Hinek A, Chaturvedi R, Almeida C, Honjo O, Koren G . Rapamycin-eluting stents in the arterial duct: experimental observations in the pig model. Circulation. 2009; 119(15):2078-85. DOI: 10.1161/CIRCULATIONAHA.107.737734. View

10.

Santoro G, Capozzi G, Caianiello G, Palladino M, Marrone C, Farina G . Pulmonary artery growth after palliation of congenital heart disease with duct-dependent pulmonary circulation: arterial duct stenting versus surgical shunt. J Am Coll Cardiol. 2009; 54(23):2180-6. DOI: 10.1016/j.jacc.2009.07.043. View

11.

Petrucci O, OBrien S, Jacobs M, Jacobs J, Manning P, Eghtesady P . Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg. 2011; 92(2):642-51. DOI: 10.1016/j.athoracsur.2011.02.030. View

12.

Feltes T, Bacha E, Beekman 3rd R, Cheatham J, Feinstein J, Gomes A . Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation. 2011; 123(22):2607-52. DOI: 10.1161/CIR.0b013e31821b1f10. View

13.

Lee K, Seto W, Benson L, Chaturvedi R . Pharmacokinetics of sirolimus-eluting stents implanted in the neonatal arterial duct. Circ Cardiovasc Interv. 2015; 8(5). DOI: 10.1161/CIRCINTERVENTIONS.114.002233. View

14.

Schneider M, Zartner P, Sidiropoulos A, Konertz W, Hausdorf G . Stent implantation of the arterial duct in newborns with duct-dependent circulation. Eur Heart J. 1998; 19(9):1401-9. DOI: 10.1053/euhj.1998.0977. View

15.

Qureshi A, Goldstein B, Glatz A, Agrawal H, Aggarwal V, Ligon R . Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting. Catheter Cardiovasc Interv. 2019; 93(5):933-943. DOI: 10.1002/ccd.28125. View

16.

Francis E, Kumar S, Kumar R . Palliative stenting of patent ductus arteriosus in older children and young adults with congenital cyanotic heart disease. Catheter Cardiovasc Interv. 2012; 83(7):1109-15. DOI: 10.1002/ccd.24373. View

17.

Gewillig M, Boshoff D, Dens J, Mertens L, Benson L . Stenting the neonatal arterial duct in duct-dependent pulmonary circulation: new techniques, better results. J Am Coll Cardiol. 2004; 43(1):107-12. DOI: 10.1016/j.jacc.2003.08.029. View

18.

Matter M, Almarsafawey H, Hafez M, Attia G, Abuelkheir M . Patent ductus arteriosus stenting in complex congenital heart disease: early and midterm results for a single-center experience at children hospital, Mansoura, Egypt. Pediatr Cardiol. 2012; 34(5):1100-6. DOI: 10.1007/s00246-012-0608-x. View

19.

Raval A, Thakkar B, Madan T, Oswal N, Garg R, Umalkar R . Ductus arteriosus stenting: A promising percutaneous palliation in patients with duct-dependent pulmonary circulation. Rev Port Cardiol. 2016; 35(11):583-592. DOI: 10.1016/j.repc.2016.06.010. View

20.

Michel-Behnke I, Akintuerk H, Thul J, Bauer J, Hagel K, Schranz D . Stent implantation in the ductus arteriosus for pulmonary blood supply in congenital heart disease. Catheter Cardiovasc Interv. 2004; 61(2):242-52. DOI: 10.1002/ccd.10766. View