61. Recanalization of patent ductus arteriosus after spontaneous closure

Abstract

Background Patency of the arterial duct (AD) needs to be preserved for a certain time in patients with duct dependent circulation. Recanalization of arterial duct might be a needed option in certain conditions. Objective To report our experience regarding the feasibility and effectiveness of arterial duct (AD) recanalization in three infants. Methods and results We report on three patients with decreased pulmonary blood flow after initial palliation. The first patient had pulmonary atresia (PA) and intact ventricular septum. The infant underwent pulmonary valve perforation and balloon valvuloplasty. He developed desaturation and needed further intervention and recanalization of the AD. The second patient had PA and ventricular septal defect (VSD). His AD originated from left subclavian artery. He had initially central shunt and clipping of duct, but required AD recanalization later. During intervention he developed a thrombus in the stent, which was treated successfully using thrombolytic treatment. The third patient had PA and VSD. The arterial duct originated from the left subclavian artery and his duct spontaneously closed in spite of prostaglandin infusion. Aortography showed pulmonary atresia, right-sided aortic arch and barely patent AD. He had AD recanalisation. During the procedure he had severe desaturation and bradycardia requiring resuscitation for two minutes. All infants had successful arterial duct recanalization and stenting. They were clinically stable during follow up waiting for subsequent procedure. Conclusion Arterial duct recanalization and stenting is a feasible and effective procedure in selected cases, and its risks are treatable.