Abstract
We aimed to study the feasibility and outcomes of transvenous approach for arterial duct stenting in patients with pulmonary atresia-ventricular septal defect. Duct-dependent hypoxic patients with pulmonary atresia-ventricular septal defect and the confluent pulmonary artery branches were enrolled for ductal stenting and followed-up regularly. Twenty-three patients, with median age of 25days (1 to 545days) and weight of 2.8kg (2.1 to 7.2kg) were enrolled. Mean baseline arterial oxygen saturation was 69.38±8.04%. Median right pulmonary artery and left pulmonary artery Z-scores were −1.53 (−4.19 to 2.48) and −1.08 (−8.03 to 3.0) respectively. Mean narrowest ductal diameter was 1.81±0.57mm and length was 13.63±3.52mm. Total 26 stents with mean diameter of 4.23±0.29mm and length of 14.88±3.65mm were deployed. Post-stenting mean arterial oxygen saturation increased significantly from baseline-value to 89.44±4.86% (p<0.0001). One patient suffered pulmonary edema. At median follow-up of 8months (3 to 10months), mean arterial oxygen saturation (78.82±8.49%) was significantly higher than baseline value of 69.38±8.04% (p=0.0004). Median right and left pulmonary artery Z-scores were 0.39 (−2.76 to 2.88) and −0.02 (−2.06 to 3.86) respectively. Five patients required re-intervention (shunt in 2 and angioplasty in 3 patients). Three patients died, one due to sepsis and another two with worsened cyanosis. Transvenous ductal stenting is an effective palliation in patients with pulmonary atresia-ventricular septal defect obviating the limitations of arterial approach.
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