Transvenous arterial duct stenting in cyanotic patients with pulmonary atresia and ventricular septal defect

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.