Lecture 7: Management of Critical CHD Neonates: Focus on PDA Stenting

Abstract

Duct-dependent pulmonary circulation is one of the most common form of critical congenital heart disease in neonates. Cyanosis is the predominant presentation symptom. Infusion of Prostaglandin E1 is helpful in maintaining short-term ductal patency. An urgent systemic-to-pulmonary artery shunt is required to maintain the blood flow supply to pulmonary arteries. But the complications related to placing a shunt to pulmonary arteries were not infrequent in neonates. With the advent of transcatheter techniques, stenting of patent ductus arteriosus (PDA) can be an alternative to systemic-to-pulmonary artery shunts. Recently, bare coronary stents have been successfully used to stent PDA. The vascular access to stent PDA can be either from a prograde route (femoral vein) or retrograde route (axillary artery). Sometimes, more than one stent is required to covert the whole length of ductus. Generally, a 3.5 mm or 4.0 mm coronary stent was used. Neonates with a non-restrictive large ductus (narrowest diameter ≥ 2.5 mm) or juxta-ductal branch pulmonary artery stenosis should be excluded. Anti-platelet agents should be given to prevent thrombosis within the stent. Although stenting PDA is a safe procedure and can be an alternative to shunt placement, complications such as stent migration, thrombus and heart failure were not uncommon.