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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Stenting the neonatal arterial duct in duct-dependent pulmonary circulation: new techniques, better results

Marc Gewillig, MD, PhD, FACC^*,*, Derize E. Boshoff, MBChB, MMed(Paed), FCP(SA)^*, Joseph Dens, MD, PhD^*, Luc Mertens, MD, PhD^* and Lee N. Benson, MD, FRCP(C)

^* Paediatric Cardiology, University Hospitals, Leuven, Belgium
Hospital for Sick Children, University of Toronto, Toronto, Canada

Manuscript received February 1, 2003; revised manuscript received May 19, 2003, accepted August 5, 2003.

^* Reprint requests and correspondence: Dr. Marc Gewillig, Paediatric Cardiology, University Hospitals Leuven B-3000 Leuven, Belgium.
marc.gewillig{at}uzleuven.be

OBJECTIVES: The goal of this study was to assess a new approach to stent the arterial duct in neonates with a duct-dependent pulmonary circulation.

BACKGROUND: Previous attempts to stent the neonatal arterial duct were unsatisfactory. Learning from these failures, we speculated that covering the complete length of the duct with current low-profile stents might avoid previous problems.

METHODS: Ten neonates with duct-dependent pulmonary circulations through a short straight duct were treated with stent implantation. The duct was crossed with an atraumatic 0.014-inch wire. A low-profile premounted coronary stent (outer diameter <4F, length 13 to 24 mm, diameter 3.0 to 4.0 mm) was positioned within the duct, not protected by a sheath; care was taken to cover the complete length of the duct from the aortaductal junction until well within the pulmonary trunk.

RESULTS: All stents could safely be deployed with adequate pulmonary flow at early- and medium-term follow-up. There were no procedure-related complications; one patient died early from sepsis. All patients had adequate relief of cyanosis for at least three to four months. During follow-up, the pulmonary vasculature bed had grown without distortion. Acute occlusion of a stented duct was not observed. Ductal flow progressively decreased slowly over several months by luminal narrowing, until the stented duct had either become redundant or was dilated/restented or until elective staged surgery was performed.

CONCLUSIONS: With current technology, complete stenting of a short straight duct is a safe and effective palliation, allowing adequate growth of the pulmonary arteries.

Abbreviations and Acronyms   PA = pulmonary artery   PBF = pulmonary blood flow

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