Patent Ductus Arteriosus Stenting in Complex Congenital Heart Disease: Early and Midterm Results for a Single-Center Experience at Children Hospital, Mansoura, Egypt

This study aimed to assess the efficacy and outcome of transcatheter ductus arteriosus stenting in newborns and infants with ductal-dependent or decreased pulmonary circulation. Between September 2009 and December 2011, 33 newborns and infants were subjected to patent ductus arteriosus (PDA) stenting as an alternative to a surgical shunt. Of the 33 patients, 20 had pulmonary atresia (PA) with a ventricular septal defect, 4 had PA with an intact ventricular septum, 5 had PA with a double-outlet right ventricle, and 4 had critical pulmonary stenosis. The McGoon ratio ranged from 0.8 to 1.9 (median 1.27). The ages of the patients ranged from 3 to 56 days, and their weight ranged from 2.7 to 4.1 kg. The oxygen saturation ranged from 45 to 61 %, and the pH ranged from 7.13 to 7.27. Premounted coronary stents with diameters of 3, 3.5, and 4 mm were used to cover the whole length of the ductus. The PDA was tortuous in 23 patients and straight in 10 patients. The mean ductal length was 12.2 ± 3.7 mm (range 7.8–23 mm). The mean stent length was 14.3 ± 3.4 mm (range, 8–23 mm), and the mean narrowest ductal diameter was 1.9 ± 0.6 mm (range, 0.8–2.9 mm). Immediately after the procedure, the oxygen saturation was increased from a mean of 75.1 ± 13.2–91.5 ± 6.3 % (p < 0.0001), and the PDA diameter was increased from a mean of 1.9 ± 0.6–4.3 ± 0.8 mm (p < 0.0001). Stent redilation was necessary in two patients 8 days after the procedure, and their oxygen saturation increased 79–88 %. The mean fluoroscopy time was 39.4 ± 15.5 min. Stent dislocation to the left main pulmonary artery was seen in one patient, with another stent placed in the arterial duct. No procedure-related mortality occurred. Two neonates died a few days after the procedure due to sepsis related to the procedure. The surviving patients were discharged home 8–30 days (median, 9.5 days) after the procedure. Stent patency was achieved for 8–550 days. The McGoon ratio increased and ranged from 1.6 to 2.8 (median, 1.87) before the surgical intervention. Glenn anastomosis was possible for 18 patients at the age of 6–8 months. Nine patients experienced worsening of cyanosis about 4 months after stent placemen. Six of these patients required a Blalock–Taussig shunt, whereas stent dilation was possible for the remaining three patients. Four patients died of severe dehydration while awaiting a Glenn shunt. The findings show that PDA stenting can be a good alternative to surgery for initial palliation, especially in infants who will need multiple surgeries. It is safe and feasible but its efficacy gradually lessens after 6 months due to intrastent endothelial hyperplasia.