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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

View larger version (167K): [in a new window]   Figure 1 Angiogram (profile) in pulmonary artery through the 5F right coronary guiding sheath. Duct constriction at the pulmonary end is clearly seen; the aortic end of the duct is wide open.

View larger version (13K): [in a new window]   Figure 2 Schematic representation of stent sizing and positioning. (A) The stent should stretch from the cranial aortoductal junction (point A), until halfway to the ductal constriction and the zenith of the ductal arch (point B). (B) When positioning and deploying the stent, the distal end of the stent should be aligned with point A without protrusion in the aorta; the proximal end of the stent will then protrude into the pulmonary trunk.

View larger version (89K): [in a new window]   Figure 3 Cine-frames showing positioning of the stent (A) and final stent position after deployment (B). The radio-opaque gastric tube is very useful as reference.