Stenting the ductus arteriosus: A "wanna-be" Blalock-Taussig.

Abstract

In 1947, Dr Helen B. Taussig wrote of the aortopulmonary surgical shunt operation that she and Dr Alfred Blalock developed to increase pulmonary artery blood flow, “The essence of the operation is the creation of an artificial ductus arteriosus through which a mixture of arterial and venous blood is directed to the lungs.”1 Who could have imagined that 50 years later, some of us would be trying to create an “artificial” Blalock-Taussig shunt through manipulation of the ductus arteriosus. Our institution has been a pioneer in neonatal cardiac transplantation since 19852 ; hence, the opportunities to explore new ways of extending the survival of the potential recipients awaiting the right donor are many. Our productive combination of a confident pediatric cardiac surgical team with a creative pediatric interventional cardiology department, operating under a Food and Drug Administration–approved protocol, began stenting the ductus arteriosus in patients with hypoplastic left heart syndrome (HLHS) who had evidence of ductal flow restriction while the patients were awaiting heart transplantation.3 It would have been too ambitious to extend the protocol to pathologic conditions other than the medically unresponsive HLHS listed for transplantation because the surgical outcomes for aortopulmonary shunts at our and most other centers have been outstanding.4 In addition, we were uncertain about stent use in general, notwithstanding their use in the ductus arteriosus; for ductus arteriosus use, only animal experience had been reported5 6 7 and, unfortunately, no good animal models for these complex congenital heart malformations exist. The use of stents to maintain the patency of the ductus arteriosus in neonates with ductal-dependent systemic blood …