Ductus Arteriosus Stenting in Newborns - Transcatheter Approach as a Bridge Therapy for Corrective Surgery

Abstract

Duct-dependent congenital heart disease requires attentive therapeutic management since the only source of pulmonary blood flow in newborns is provided by the patent ductus arteriosus. The patency of the duct is the main objective in the first hours of life and it is guaranteed by prostaglandin E1 infusion, but it is not a long-term solution for this type of cardiac malformation. In order to augment pulmonary blood, there are two types of interventions that can be performed: a classical surgical shunt or stenting of the ductus arteriosus, a fairly new alternative to cardiac palliative surgery. Case selection for this type of procedure is essential regarding the patients' outcome. We present the management of a newborn diagnosed with (pseudo)atretic pulmonary valve, large ventricular septal defect and patent ductus arteriosus, who underwent an interventional procedure to secure pulmonary blood flow by placing a drug-eluting stent in the ductus arteriosus. The patient's evolution was not uneventful, several complications appeared, but after three months of neonatal intensive care we were able to discharge him in good clinical condition.

FIGURE 1.

Contrast injection at the connection between the aortic arch and patent ductus arteriosus with visualization of the patent ductus arteriosus anatomy, the pulmonary artery and its branches.

FIGURE 2.

Guidewire positioned in the distal right pulmonary artery through the patent ductus arteriosus

FIGURE 3.

Different projections used in angiography to assess stent position: anteroposterior (left image) and left anterior oblique (right image)

FIGURE 4.

Imaging the stent implantation in the ductus arteriosus at control angiography (left image) and X-ray (right image)

FIGURE 5.

A. Biventricular hypertrophy, left-to-right ASD shunt. B. Color Doppler flow of the stent from the suprasternal view