A Case Report of Embolized Stent and Rashkind Septostomy that Suffer Hemolysis Due to Stent in 2-Days Neonate with Pulmonary Atresia and Single Ventricle

Abstract

Introduction: Stenting in patent ductus arteriosus (PDA) and Rashkind septostomy in neonates with pulmonary atresia improves pulmonary and systemic venous blood mixing and oxygen saturation. In the present study, a case of embolized stent and Rashkind septostomy that suffered hemolysis due to the stent was reported in a 2-day neonate with pulmonary atresia and single ventricle. Case Presentation: The patient was a 2-day-old boy neonate with a gestational age of 35 ± 2 weeks and a birth weight of 2800 grams. Neonates' vital signs after birth were abnormal, and in the examination, cyanosis, tachypnea, grunting, and respiratory distress were observed. Auscultation had a systolic murmur at the left upper edge of the sternum. O2 saturation was about 70%, with a nasal oxygen intake of 3 L/min. Echocardiography confirmed the presence of pulmonary atresia and PDA. The initial treatment was done with prostaglandin E1, stenting in PDA, and a Rashkind septostomy. The neonate's cardiac arrest occurred during stenting, and the neonate was resuscitated. The angiography examination indicated PDA stent embolization in the pulmonary artery, and due to the unsuccessful restoration of the stent, a decision was made to use a larger stent in the PDA. The neonate suffered from hemolysis on the second day and was discharged with conservative treatment within 2 weeks with a good general condition. Conclusions: Keeping the PDA open with a proper stent and creating a Rashkind atrial septostomy improves the two-way mixing of pulmonary and systemic venous blood and oxygen saturation of neonates with pulmonary atresia and eliminates the need for surgery.