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CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Initial results and medium-term follow-up of stent implantation of patent ductus arteriosus in duct-dependent pulmonary circulation

^* National Heart Institute, Kuala Lumpur, Malaysia

Manuscript received December 3, 2003; revised manuscript received March 19, 2004, accepted March 30, 2004.

^* Reprint requests and correspondence: Dr. Mazeni Alwi, Department of Paediatric Cardiology, Institut Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia.
mazeni{at}ijn.com.my

OBJECTIVES: This study was designed to assess the safety, efficacy, medium-term outcome, and complications of patent ductus arteriosus (PDA) stenting in duct-dependent pulmonary circulation.

BACKGROUND: Patent ductus arteriosus stenting has been proposed as an alternative to surgical shunt on account of postoperative morbidity and complications of surgical shunting.

METHODS: Between April 2000 and February 2003, 69 patients with duct-dependent pulmonary circulation underwent cardiac catheterization with the intent of PDA stenting as first palliative procedure. Patients with critical pulmonary stenosis and pulmonary atresia with intact ventricular septum post-radiofrequency valvotomy who had PDA stenting were excluded. Thirteen more patients were excluded because of branch pulmonary artery (PA) stenosis. The follow-up was by clinical examination, echocardiography, and repeat cardiac catheterization at six to nine months following the procedure.

RESULTS: Patent ductus arteriosus stenting was successful in 51 patients (91.1%) and failed in 5 patients (8.9%). The mean narrowest PDA diameter was 1.9 ± 0.6 mm. The mean procedure and fluoroscopy time were 95.7 min and 29.4 min, respectively. In one patient the stent dislodged and migrated to the left femoral artery and another patient developed transient intravascular hemolysis. There was no procedure-related mortality. Three patients (5.9%) died one day to two months after the procedure. At follow-up (3.2 months to 2.4 years), 8 patients developed significant stent stenosis requiring reintervention. Seven patients developed worsening of preexisting branch PA stenosis. The freedom from reintervention was 89% and 55% at 6 months and 1 year, respectively.

CONCLUSIONS: Patent ductus arteriosus stenting is an attractive alternative to surgical shunt in a majority of patients with duct-dependent circulation. An absolute contraindication to this technique is the presence of branch pulmonary stenosis.

Abbreviations and Acronyms   BT = Blalock-Taussig   LPA = left pulmonary artery   PA = pulmonary artery   PAIVS = pulmonary atresia with intact ventricular septum   PDA = patent ductus arteriosus   PS = pulmonary stenosis   RF = radiofrequency   RPA = right pulmonary artery   RV = right ventricle   TOF = tetralogy of Fallot   VSD = ventricular septal defect

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