Stent implantation into ductus arteriosus: a new alternative of palliative treatment of duct-dependent pulmonary circulation
Keywords:
stent implantation, duct-dependent pulmonary circulation, PDA, McGoon ratio
Abstract
Background The technical aspects of ductal stenting have beenreported, but little is known about the fate of the duct after stent
implantation.
Objectives To determine the effects of PDA stenting on the degree
of cyanosis, blood oxygen saturation, long-term patency of PDA,
and the growth of pulmonary artery and its branches, in patients
with duct-dependent pulmonary circulation.
Methods This was a case series study conducted at the Depart-
ment of Pediatric Cardiology, Institut Jantung Negara (National Heart
Institute), Kuala Lumpur, Malaysia from November 1996 to Septem-
ber 2001 on patients with duct-dependent pulmonary circulation who
underwent stent implantation. All patients were followed-up until oc-
clusion or block occurred or until the end of follow-up time. The evalu-
ation consisted of clinical manifestations, electrocardiography, chest
x-ray, echocardiography, and cardiac catheterization.
Results Stent was successfully implanted in 60 patients (84%),
failed in 7 patients (10%) and contra indicated in 4 patients (6%).
There was significant improvement on the degree of cyanosis after
stent implantation (p<0.0001). The blood oxygen saturation signifi-
cantly increased from 74% (ranged 42-93; SD 12) before proce-
dure, to 90% (ranged 62-100; SD 8) afterward (p<0.0001). The mean
duration of follow-up time was 14.2 months (ranged 2.5-50.8; SD
13) and the minimal patency of PDA was 11.2 months (ranged 1.1-
47.7; SD 10.7) after implantation. At the end of follow-up, the stents
were widely patent in 33 patients (55%), stenotic in 15 patients (25%)
and spontaneously occluded in 12 patients (20%). There was in-
creased growth of pulmonary artery as measured by McGoon ratio
from 1.23 (ranged 0.4-2.3; SD 0.4) to 1.81 (ranged 0.7-0.9; SD 0.57),
and no distortion of pulmonary artery and its branches found.
Conclusion Stent implantation into ductus arteriosus decreased
the degree of cyanosis, increased blood oxygen saturation, main-
tained long-term patency of ductus arteriosus, and promoted the
increased growth of pulmonary artery without distortion of pulmo-
nary artery and its branches
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after balloon dilatation: an experimental study. Circu-
lation 1983;68:621-7.
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Sibbons P. Radio frequency thermal angioplasty main-
tains arterial duct patency. An experimental study. Cir-
culation 1994;90:442-8.
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Kakadekar AP, Baker EJ, et al. Medium-term results of
experimental stent implantation into the ductus arte-
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ventricular septum percutaneous radio frequency-
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cal interventional of neonates with critical congenital
heart disease. Indones J Pediatr Cardiol 2002;1:4-6.
2. Gibbs JL, Uzun O, Blackburn MEC, Wren C, Hamilton
JRL, Watterson KG. Fate of the stented arterial duct.
Circulation 1999;99:2621-5.
3. Schneider M, Zartner P, Sidiropoulos, Konetz W,
Hausdorf G. Stent implantation of the duct in new-
borns with duct-dependent circulation. Eur Heart J
1998;19:1401-9.
4. Ruiz CE, Gamra H, Zhang HP, Garcia EJ, Boucek MM.
Brief report: stenting of the ductus arteriosus as a bridge
to cardiac transplantation in infants with the hypo-
plastic left heart syndrome. New Engl J Med
1993;328:1605-8.
5. Rao PS. Interventional pediatric cardiology: state of art
and future directions. Pediatr Cardiol 1998;19:107-24.
6. Freed MD, Heymann MA, Lewis AB, Roehl SL, Kensey
RC. Prostaglandin E1 in infants with ductus arterio-
sus-dependent congenital heart disease. Circulation
1981;64:899-905.
7. Lewis AB, Freed MD, Heyman MA, Roehl SL, Kensey
RC. Side effect of prostaglandin E1 in infants with
critical congenital heart disease. Circulation
1981;64:893-8.
8. Rudolph AM, Heyman MA, Fishman N, Lakier JB.
Formalin infiltration of the ductus arteriosus. A method
for palliation of infants with selected congenital car-
diac lesions. N England J Med 1975;292:1263-8.
9. Lund G, Rysavy J, Cragg A, Salomonowitz E, Vlodaver
Z, Zuniga WC, et al. Long-term patency of the ductus
arteriosus after balloon dilatation: an experimental
study. Circulation 1984;69:772-4.
10. Lund G, Cragg A , Rysavy J, Castenada F, Salomonowitz
E, Vlodaver Z, et al. Patency of the ductus arteriosus
after balloon dilatation: an experimental study. Circu-
lation 1983;68:621-7.
11. Abrams SE, Walsh KP, Diamond MJ, Clarkson MJ,
Sibbons P. Radio frequency thermal angioplasty main-
tains arterial duct patency. An experimental study. Cir-
culation 1994;90:442-8.
12. Rosenthal E, Qureshi SA, Tabatabaie AS, Persaud D,
Kakadekar AP, Baker EJ, et al. Medium-term results of
experimental stent implantation into the ductus arte-
riosus. Am Heart J 1996;132:657-63.
13. Alwi M, Kandhavello G, Bilkis AA, Lim MK, Samion
H, Latiff HA, et al. Pulmonary atresia with intact
ventricular septum percutaneous radio frequency-
assisted valvotomy versus surgical valvotomy and
Blalock Taussig shunt. J Am Coll Cardiol
2000;35:468-76.
Published
2016-10-10
How to Cite
1.
Djer M, Madiyono B, Sastroasmoro S, Putra S, Oesman I, Advani N, Alwi M. Stent implantation into ductus arteriosus: a new alternative of palliative treatment of duct-dependent pulmonary circulation. PI [Internet]. 10Oct.2016 [cited 7May2024];44(1):30-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/730
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Received 2016-09-28
Accepted 2016-09-28
Published 2016-10-10
Accepted 2016-09-28
Published 2016-10-10
