Ductal Stenting to Retrain the Involuted Left Ventricle in a Late Presenter Infant With Transposition of the Great Arteries, Intact Interventricular Septum

Abstract

INTRODUCTION: Ductal stenting can be a nonsurgical option and less morbid method to provide pressure and volume overload to the regressing left ventricle in late presenters of transposition of the great arteries, intact ventricular septum (TGA-IVS), prior to arterial switch operation (ASO). CASE PRESENTATION: This is a case of an infant diagnosed with TGA-IVS beyond the neonatal period who underwent balloon atrial septostomy and ductal stenting to retrain involuted left ventricle prior to definitive ASO. DISCUSSION: Ductal stenting is an alternative option in late presenters of transposition of the great arteries with involuted left ventricle. It provides volume loading and, to a lesser extent, pressure loading leading to left ventricular hypertrophy. Also, presence of the stented duct allows improved oxygenation eliminating the need for aortopulmonary shunt. It can be a less morbid method of left ventricular training because it avoids hemodynamic stress, pulmonary artery distortion, and neoaortic valve regurgitation. CONCLUSION: Ductal stenting in late presenters with TGA-IVS successfully retrains the left ventricle and achieves safe late ASO. KEYWORDS: congenital heart disease, transposition of great arteries, PDA stenting, arterial switch operation