Ductus Arteriosus Stenting in Neonates with Pulmonary Valve Atresia: Outcomes and Considerations

医学 动脉导管 肺动脉闭锁 外科 左肺动脉 支架 肺动脉 心脏病学 狭窄 左心发育不良综合征 败血症 肺动脉瓣 内科学 心脏病
作者
Mohammadreza Edraki,Leila Jouhari,Amir Naghshzan,Hamid Amoozgar,Hamid Mohammadi,Gholam Hossein Ajami,Nima Mehdizadegan,Kambiz Keshavarz,Bahram Ghasemzadeh
出处
期刊:Iranian Journal of Pediatrics [Kowsar Medical Institute]
卷期号:32 (5)
标识
DOI:10.5812/ijp-119742
摘要

Background: Patent ductus arteriosus (PDA) stenting was invented particularly for congenital heart diseases with ductal-dependent pulmonary blood flow, and newer techniques are constantly being introduced. Objectives: In this study, we investigate the one-year results of this procedure and describe some of our periprocedural considerations. Methods: The neonates with pulmonary atresia and ventricular septal defect (VSD) who underwent PDA stenting in our center from February 2016 to December 2019 were included in this retrospective study. Spo2 and McGoon ratios were recorded before and a year after stenting and compared to each other. Results: In 26 neonates, PDA stenting was performed; 20 procedures (77%) were successful, and six procedures (23%) were unsuccessful. Two of these unsuccessful cases died during the procedure, and two of them died as a result of neonatal sepsis following the procedure. A total of 18 PDAs (70%) were accessed via the axillary artery, 6 (23%) via the femoral artery, and 2 (7%) via the antegrade inferior vena cava route. The comparison between the results before and one year after stenting revealed the increase of O2 saturation from 53.78 ± 7.35 to 84.33 ± 6.5 (P-value = 0.032) and McGoon ratio from 1.16 ± 0.25 to 1.65 ± 0.34 (P-value = 0.041). Additionally, we discussed some technical considerations of PDA stenting, including the access point, management of pulmonary artery bifurcation stenosis, stent diameter, stenting of long and tortuous PDAs, thrombosis, and anticoagulation. Conclusions: Ductal stenting increases SpO2 and McGoon ratio and could be a less-invasive option for securing pulmonary blood circulation. However, further studies are required to advance PDA stenting techniques for specific anatomical features.

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