Arterial Duct Stenting in Duct-Dependent Pulmonary Circulation

Study Questions:

What is the effect of arterial duct stenting in patients with congenital heart disease with completely ductal-dependent pulmonary blood flow (PBF)?

Methods:

A retrospective review was performed at a single center. Pulmonary artery (PA) growth was evaluated as Nakata index and McGoon ratio as well as individual PA z-score changes. Patients underwent angiography 7.2 ± 6.4 months after arterial duct stenting.

Results:

A total of 49 patients underwent ductal stenting during the study period, of which 15 had completely ductal-dependent PBF and 34 had multiple PBF sources. In the whole population, significant PA growth was seen, with Nakata index increasing from 144 ± 73 to 271 ± 86 and McGoon ratio increasing from 1.4 ± 0.3 to 2.0 ± 0.4 (p = 0.0001 for both). No difference was seen in percentage increase of global and branch vessel size in patients with completely ductal-dependent PBF, as compared with those with multiple PBF sources.

Conclusions:

The authors concluded that percutaneous arterial duct stenting was associated with significant balanced PA growth in patients with congenital heart disease and completely ductal-dependent pulmonary circulation over the short-term. Ductal stenting may be considered an alternative to surgical palliation for this group of patients.

Perspective:

Stenting of the arterial duct, generally with coronary balloons, has been advocated as an alternative to surgical shunt placement, particularly in patients at high risk for surgical intervention. This study shows good PA growth after arterial duct stenting in patients with and without completely ductal-dependent PBF. The primary limitation of this study is that it is a small study at a single, experienced center such that the results may not be readily generalizable to other centers. However, stenting of the arterial duct does appear to be a viable option for patients with and without completely ductal-dependent PBF.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Congenital Heart Disease, CHD & Pediatrics and Imaging, CHD & Pediatrics and Interventions, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging

Keywords: Angiography, Ductus Arteriosus, Heart Defects, Congenital, Pulmonary Artery, Pulmonary Circulation, Stents


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