Percutaneous Transcatheter Closure of a Stented Patent Ductus Arteriosus in a Patient With Critical Pulmonary Stenosis: A Case Series

Abstract

INTRODUCTION: TStenting of the ductus is an alternative to surgical shunt in patients with critical pulmonary stenosis who remain ductal dependent following valvuloplasty. Stents close spontaneously after improvement of right ventricular function; however, in rare cases, stents fail to completely endothelialize, resulting in pulmonary overcirculation. CASE PRESENTATION: The first case was a 3-year-old who had critical pulmonary stenosis at birth, and the second case was a 3-year-old boy who at 5 months of age was managed for severe pulmonary valve stenosis. Both underwent stenting of the duct and percutaneous pulmonary balloon valvuloplasty. On follow-up, the patent ductus arteriosus (PDA) stent of both cases remained patent even after an adequate growth and improvement of the right ventricle, resulting in significant left-to-right shunting and development of increased pulmonary blood flow; hence, percutaneous transcatheter closure of the stented PDA was done. DISCUSSION: Stenting of the ductus allows significant and balanced growth of the pulmonary artery in patients with duct-dependent congenital heart diseases leading to adequate growth of the right ventricle. Persistence of patency of stent causing significant left-to-right shunting warrants closure of the PDA stent. Closure of the stent is challenging and requires a high degree of technical skill because of the difficulty to enter the partially closed stent. CONCLUSION: Percutaneous transcatheter closure of a stented PDA in patients with critical pulmonary stenosis can be a technically challenging procedure because of the difficulty to enter the stent due to the presence of intrastent endothelial proliferation. KEYWORDS: congenital heart disease, critical pulmonary stenosis, patent ductus arteriosus, transcatheter device closure, stent