Patent Ductus Arteriosus Stenting Research Articles

Anesthesia in A Patient with Pulmonary Atresia with Intact Ventricular Septum (PA IVS) Underwent Bidirectional Cavo-Pulmonary Shunt (BCPS)

Background: Pulmonary atresia with intact ventricular septum (PA-IVS) is a rare condition, encompassing approximately 1%–3% of congenital heart diseases. Patients with PA-IVS have functional single-ventricle physiology. The ultimate possible outcomes for patients with PA-IVS are biventricular circulation, 1.5-ventricle or single-ventricle palliation, or cardiac transplantation. The bidirectional cavopulmonary shunt (BCPS) procedure directs flow from the superior vena cava into both the right and left pulmonary arteries, permitting flow to both lungs. The shunt is considered to be the second stage of palliation and is generally preparative for the third-stage Fontan procedure. The BCPS improves systemic arterial oxygen saturation without increasing ventricular work or pulmonary vascular resistance.Case: A 10-month-old, 25-day-old boy, weight 9.93 kg, body length 72 cm, diagnosed with PA-IVS, restricted persistent foramen ovale (PFO), right ventricle hypoplastic, and turtuous patent ductus arteriosus (PDA), underwent BCPS, atrial septectomy, and PDA stent evacuation surgery. The patient underwent a PDA stenting and ballooning atrial septectomy (BAS) at 17 days of age at the cathlab. The patient was cyanotic with stable hemodynamics and a saturation of 72% preoperatively.Discussion: Preoperative fasting must be observed to maintain the patient's hydration state. Pulmonary blood flow and systemic blood flow must be balanced. An adequate analgetic can prevent pain stimuli that increase pulmonary vascular resistance. Drugs to reduce the afterload, such as milrinone, are needed. Mechanical ventilation was set to get PaCO2 between 40 and 45 mmHg. Maintain the normal heart beat, preload, and contractility to maintain cardiac output (CO) with saturation 80–85%. Wean from mechanical ventilation as soon as possible.Conclusion: Anesthetic management for BCPS in patients with single ventricles from the preoperative period, intraoperative period, and postoperative period. Understanding single ventricle phsiology is important in order to treat the patient.

Comparison of the Effectiveness of Ductus Arteriosus Stenting and Systemic-to-Pulmonary Artery Shunt Placement in a Cohort of Newborns with Duct-Dependent Pulmonary Circulation

Comparison of the Effectiveness of Ductus Arteriosus Stenting and Systemic-to-Pulmonary Artery Shunt Placement in a Cohort of Newborns with Duct-Dependent Pulmonary Circulation

Results of a hybrid approach for high risk term newborn patients with interrupted aortic arch (IAA) with left ventricular outflow tract obstruction.

This study aims to share the results of critically ill newborn cases with interrupted aortic arch (IAA) and Left ventricular outflow tract (LVOT) obstruction (LVOTO) who underwent the hybrid approach, which consists of bilateral pulmonary artery banding and/or patent ductus arteriosus stenting, as first-line treatment. This retrospective study includes the results of high-risk term newborns whom we applied a hybrid approach due to IAA and LVOTO in our clinic between January 1, 2021 and December 31, 2021. The demographic characteristics, hybrid approach methods and results of the cases were evaluated. Nine cases underwent hybrid approach during the study period. The mean age and weight at interventions were 7 days (3-16 days) and 3280 g (2700-4300 g). Six of the patients were diagnosed with type B IAA, 2 with type A, and one with type C. LVOTO was present in 7 patients. The success rate for the procedures was 100%. No patients died during the procedure or within the first 5 days after the procedure or from reasons related to the procedure. The median length of the hospital stay after stent placement was 28 days (22-35 days) for discharged patients. Three patients died in interstage period, and 6 patients underwent total corrective surgery after a median of 7 months (4-10 months). The average LVOT diameter was increased from 3.1 mm to 4.8 mm before total repair surgery. The hybrid approach should be kept in mind for treating high risk newborns with IAA with LVOTO and high-risk newborns who are not suitable for single stage total corrective surgery.

Stage 1 and 2 Palliation: Comparing Ductal Stenting and Aorto-Pulmonary Shunts in Single Ventricles with Duct-Dependent Pulmonary Blood Flow

Patent ductus arteriosus stenting (PDAS) for ductal-dependent pulmonary blood flow (DDPBF) provides a new paradigm for managing neonates with single ventricles (SV). Currently, sparse data exist regarding outcomes for subsequent palliation. We describe our experience with inter-stage care and stage 2 (S2P) conversion with PDAS in comparison to a prior era of patients who received surgical aorto-pulmonary shunts (APS). Retrospective review of 18 consecutive DDPBF SV patients treated with PDAS between 2016 and 2021 was done and compared with 9 who underwent APS from 2010 to 2016. Patient outcomes and pulmonary artery (PA) growth were analyzed. S2P was completed in all 18 with PDAS with no cardiac arrests and one post-S2P mortality. In the 9 APS patients, there was one cardiac arrest requiring ECMO and one mortality inter-stage. Off cardiopulmonary bypass strategy was utilized in 10/18 in the PDAS and 1/9 in the APS group (p = 0.005) at S2P. Shorter ventilation time, earlier PO feeding, and shorter hospital stay were noted in the PDAS group (p = 0.01, p = 0.006, p = 0.03) (S2P). Median Nakata index increase inter-stage was not significant between the PDAS and APS at 94.1 mm2/m2 versus 71.7 mm2/m2 (p = 0.94). Median change in pulmonary artery symmetry (PAS) was − 0.02 and − 0.24, respectively, which was statistically significant (p = 0.008). Neurodevelopmental outcomes were better in the PDAS group compared to the APS group (p = 0.02). PDAS provides excellent PA growth, inter-stage survival, progression along multistage single-ventricle palliation, and potentially improved neurodevelopmental outcomes. Most patients can be transitioned through 2 stages of palliation without CPB.

The effectiveness of the flip technique in vertical ductal stenting.

In this study, the flip technique was compared with the classical method in terms of procedural success and procedure time during ductal stent implantation (DSI) via the carotid artery in patients whose pulmonary blood flow is dependent on the vertical type of ductus arteriosus (DA). Between January 2019 and June 2023, 40 patients (24 males, 16 females; mean age: 15.9±15.4 days; range, 1 to 68 days) with vertical ductus-dependent pulmonary circulation who underwent patent DA stent implantation via the carotid artery were included in the study. Patients were divided into two groups: those who underwent the flip technique (Group 1) and those who did not undergo the flip technique (Group 2). Data were retospectively compiled by reviewing patient files and catheter images. Demographic findings were similar in the groups. The distribution of the DA in terms of tortuosity index was also similar in the groups. The procedure was successful in 18 (90%) patients in Group 1 and 20 (100%) patients in Group 2. There was no procedure-related mortality in both groups. The frequency of procedure-related complications was similar. Procedure duration was 53.6±18.4 min in Group 1 and 41.5±9.1 min in Group 2; the difference was significantly lower in Group 2 (p=0.028). The shorter follow-up in Group 2 was attributed to the flip method starting to be used later in the clinic. During follow-up, stent dilatation was required in two patients in Group 1 and one patient in Group 2, and a second stent implantation was needed in one patient in Group 2. No significant difference was observed between the two groups in terms of reintervention. The success rate of DSI using the carotid artery access is high with both the classical and the flip method in patients with vertical DA. However, the use of the flip technique could be preferred in terms of operator habituation, ergonomic use of the catheter, guidewires, and shorter procedure time.

Ductus Arteriosus Stenting as a Method of Palliative Treatment of Truncus Arteriosus Type A3: Literature Review and Clinical Case

Introduction. Van Praagh A3 variant of truncus arteriosus (TA A3) is a condition when the one pulmonary artery branch origins from the TA, the other is filled through the patent ductus arteriosus (PDA).
 PDA constriction in the early neonatal period can cause absence of blood supply to the one pulmonary artery branch. To prevent this, prolonged infusion of prostaglandin E1, PDA stenting or systemic-to-pulmonary shunt are used. These methods allow to postpone total repair (TR) and reduce mortality risks associated with neonatal period.
 The aim. To analyze research papers dedicated to endovascular approach of TA A3 staged treatment and to present our own experience.
 Materials and methods. We conducted a systematic literature search and analyzed various options for the TA A3 staged treatment. After the review, we used endovascular approach as the first stage of treatment in our clinical case.
 We studied a newborn weighing 4 kg with TA A3 (left pulmonary artery branch origins from the non-coronary sinus of the truncal valve, right pulmonary artery branch filling through the PDA). Nakata index was 83 mm2/m2. McGoon ratio was 1. We decided to perform PDA stenting with the aim of postponing surgical correction until the patient’s optimal age and weight.
 Discussion. In total, the number of publications about TA A3 staged treatment is limited. Most institutions prefer TA A3 staged treatment in newborns, because it is associated with a lower risk of complications than early TR. In our clinical case, the first step was PDA stenting. The staged approach allowed us to perform TR with a good result at the age of 3 months. Before TR, Nakata index and McGoon ratio were increased to 248 mm2/m2 and 1.9, respectively.
 Conclusions. The current trend of TA A3 repair has few different options of staged treatment. Staged approach helps to get out of the newborn period and achieves the optimal condition for TR. Our patient successfully received PDA stenting as the first stage of treatment, which created conditions for the pulmonary artery branches growth. The second stage was TR with good long-term results. After analyzing the publications, we noted that the use of endovascular PDA stenting is a good and safe alternative to surgical palliative treatment.

Blalock-Taussig Shunt versus Ductal Stenting as Palliation for Duct-Dependent Pulmonary Circulation.

There is limited data published from outside North America and Europe comparing the outcomes of a modified Blalock-Taussig shunt (MBTS) and ductal stenting as the first palliative procedure for infants with duct-dependent pulmonary circulation. This study reports the National Heart Center's, in Muscat, Oman, experience in comparing the outcomes of these 2 interventions. This retrospective study included all infants with duct-dependent pulmonary circulation who received either a MBTS or ductal stenting from 2016-2019. The primary outcomes were death or re-interventions. Secondary outcomes included death, subsequent re-interventions, survival to subsequent surgical intervention, survival to hospital discharge, post-procedural mechanical ventilation and duration of intensive care unit stay. A total of 71 patients were included in the study, 33 (46%) of whom received ductal stenting. The prevalence of the primary outcome (death or re-intervention) in the patent ductus arteriosus (PDA) stent group was 54.5% versus 31.6% in the MBTS group but this was not statistically significant (P = 0.06). There was no difference between the 2 groups in terms of time to next surgical intervention (P = 0.233). The PDA stent group had shorter post-procedural, mechanical ventilation and intensive care unit stay durations (P <0.05). Syndromic patients were at higher risk of mortality compared to non-syndromic patients. MBTS and ductal stenting are both acceptable modalities as a palliative intervention for infants with duct-dependant pulmonary circulation. Syndromic patients are at higher risk of mortality. This can be considered an important factor for patient selection.

A Case Report of Embolized Stent and Rashkind Septostomy that Suffer Hemolysis Due to Stent in 2-Days Neonate with Pulmonary Atresia and Single Ventricle

Introduction: Stenting in patent ductus arteriosus (PDA) and Rashkind septostomy in neonates with pulmonary atresia improves pulmonary and systemic venous blood mixing and oxygen saturation. In the present study, a case of embolized stent and Rashkind septostomy that suffered hemolysis due to the stent was reported in a 2-day neonate with pulmonary atresia and single ventricle. Case Presentation: The patient was a 2-day-old boy neonate with a gestational age of 35 ± 2 weeks and a birth weight of 2800 grams. Neonates' vital signs after birth were abnormal, and in the examination, cyanosis, tachypnea, grunting, and respiratory distress were observed. Auscultation had a systolic murmur at the left upper edge of the sternum. O2 saturation was about 70%, with a nasal oxygen intake of 3 L/min. Echocardiography confirmed the presence of pulmonary atresia and PDA. The initial treatment was done with prostaglandin E1, stenting in PDA, and a Rashkind septostomy. The neonate's cardiac arrest occurred during stenting, and the neonate was resuscitated. The angiography examination indicated PDA stent embolization in the pulmonary artery, and due to the unsuccessful restoration of the stent, a decision was made to use a larger stent in the PDA. The neonate suffered from hemolysis on the second day and was discharged with conservative treatment within 2 weeks with a good general condition. Conclusions: Keeping the PDA open with a proper stent and creating a Rashkind atrial septostomy improves the two-way mixing of pulmonary and systemic venous blood and oxygen saturation of neonates with pulmonary atresia and eliminates the need for surgery.

Efficacy and safety of transcarotid compared to transfemoral approach of patent ductus arteriosus stenting in duct-dependent cyanotic heart disease

BackgroundMinimally invasive transcatheter approaches were usually done for patent ductus arteriosus (PDA) with duct-dependent pulmonary circulation. There are two ways to establish vascular access, by using transfemoral either femoral vein (FV) or femoral artery (FA) and transcarotid artery (CA) with surgical cutdown approach to access the PDA and then provide good support for the balloon and the stent to be safely deployed. This study aims to compare the efficacy and safety of transcarotid with surgical cutdown compared to the transfemoral approach of patent ductus arteriosus stenting in duct-dependent cyanotic heart disease.ResultsOverall procedural complication rates were higher in the FA/FV approach than in the CA approach (51% vs. 30%). The incidence of acute limb ischemia in the FA approach is significantly higher than in the CA approach (P < 0.05). No acute thrombosis/occlusion of the carotid artery was assessed by carotid vascular ultrasound in 2-day series.ConclusionsThe transcarotid approach with surgical cutdown may offer a secure and more efficient means of accessing the PDA, particularly for those emerging from the underside of the aortic arch.

First Experience of Patent Ductus Arteriosus Stenting in Neonate with Pulmonary Atresia and Intact Ventricular Septum in North Sulawesi, Indonesia

Abstract: Stenting of patent ductus arteriosus (PDA) is a minimally invasive catheter-based temporary palliative procedure, and it serves as an alternative to surgical shunt in neonates with duct dependent pulmonary perfusion, such as pulmonary atresia. This presentation aimed to report the first experience of PDA stenting in a neonate with pulmonary atresia in North Sulawesi, Indonesia. We reported a female neonate patient, weighing 3775 grams, referred from primary hospital with suspect congenital heart disease. The patient was born at 40 weeks of gestational age by caesarean section delivery from a primigravid mother aged 23 years with inertia uteri and strangulation of nuchal cord. At birth, she cried immediately and her APGAR score was 6-7. On her first day of life, she looked cyanotic, therefore she was referred to Prof. Dr. R. D. Kandou Hospital. Physical examination showed that she had perioral cyanotic and peripheral cyanotic with SpO2 58%. Chest X-ray showed cardiomegaly. Echocardiography revealed pulmonary atresia with PDA with intact ventricular septum. PDA stenting was done on her second day of admission. After the procedure, she was clinically stable with SpO2 80%, and was treated with intravenous antibiotic, and intravenous heparin and aspirin enterally. On the third day post procedure, she was discharged and no complication was found. PDA stenting in patient with duct-dependent pulmonary circulation appeared to be an alternative to surgery. It provided bridging palliation until the time of definitive surgery. The effectiveness of the procedure was highlighted by the fact that all the patients showed significant improvement in arterial saturation and pulmonary vascular marking. In conclusion, PDA stenting is considered feasible, safe and associated with lower mortality rates and shorter hospital length of stay than systemic-pulmonary surgical shunt procedure. Early detection and timely management are imperative to save the life. Keywords: patent ductus arteriosus stenting; pulmonary atresia

Fetal pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum: a single-center clinical experience.

Fetal pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum: a single-center clinical experience.

Spinal anesthesia for a neonate with complex congenital heart disease for lower limb surgery

A neonate with complex congenital heart disease was referred for patent ductus arteriosus (PDA) stenting, who had an ulceration of the dorsum of the foot secondary to extravasation injury. Echo showed situs solitus, levocardia, atrioventricular concordance, double-outlet right ventricle, large inlet with conoventricular ventricular septal defect, bidirectional shunt, D-posed aorta, pulmonary atresia, confluent good-sized branch pulmonary arteries, left arch, no coarctation, and tortuous PDA arising from the base of arch supplying the branch pulmonary artery confluence. Three days later, PDA stenting was done. As limb ulceration progressed to cellulitis, he was posted for debridement and VAC application 6 days after PDA stenting. It was performed under subarachnoid block with 0.5% bupivacaine heavy 0.6 ml through L4-L5 interspace using a 24G needle. Intraoperatively, saturation and hemodynamic variables remained stable. Skin grafting was performed 3 days later under spinal anesthesia with an unremarkable intraoperative and postoperative period.

Comparison of Patent Ductus Arteriosus Stenting and Blalock-Taussig Shunt in Ductal Dependent Blood Flow Congenital Heart Disease and Decreased Pulmonary Blood Flow.

Congenital ductal-dependent cyanotic congenital heart disease (CHD) is a group of diseases that require early intervention during early infancy or the neonatal period. In this study, we compared the effectiveness, safety, and side effects of stenting patent ductus arteriosus versus a modified Blalock-Taussig (BT) shunt. Thirty-six neonates and infants with cyanotic CHD who were <6 months old and were not suitable for complete surgery were admitted to Chamran Hospital in Isfahan and enrolled in this prospective longitudinal cross-sectional study. Ductal stenting (DS) was performed in 18 patients and BT shunt in 18 patients. Data were collected and compared in these patients. Age, height, and weight were lower in the DS group compared to the shunt group (1.28 ± 0.46 vs. 2.50 ± 0.51 months, 53.22 ± 1.80 vs. 56.11 ± 1.67 cm, 3.38 ± 0.45 vs. 4.98 ± 0.57 kg, respectively P < 0.001). The duration of the intensive care unit stay as well as hospital stay in patients in the DS group was much shorter than the shunt group (1.33 ± 0.68 vs. 2.83 ± 0.70 days, 3.33 ± 0.68 vs. 9.55 ± 0.51, P < 0.001, respectively). In both groups, the diameter of the pulmonary branches increased after the procedure compared to before the procedure (P < 0.001). Furthermore, the patient's hemoglobin was significantly decreased compared to before the procedure (P < 0.001). In both groups, one patient died in the postprocedure period. In ductal stent group one patient died in catheterization lab and in shunt group died 48 hours after surgery. There was no significant difference in postprocedural complications between the two groups. Duct stents can be used as an effective and safe method in duct-dependent cyanotic CHD patients who are not suitable candidates for complete surgery. As operators become proficient, this method can be a good alternative to BT shunts with fewer complications.

Association of Bulboventricular Foramen Size and Need for Early Intervention in Infants with Tricuspid Atresia or Double-Inlet Left Ventricle with Normally Related Great Arteries

The association of bulboventricular foramen (BVF) size and systemic outflow adequacy has been studied in patients with tricuspid atresia (TA) or double-inlet left ventricle (DILV) with transposed great arteries. The aim of this study was to determine the relationship between initial BVF size and risk for progressive pulmonary outflow obstruction requiring intervention to increase pulmonary blood flow in patients with TA or DILV with normally related great arteries. Patients with TA or DILV with normally related great arteries were identified by retrospective chart review at a single center from 2005 to 2021. Patients were stratified by indexed BVF area (iBVFA) to determine the relationship of iBVFA size and the need for intervention before the Glenn operation to establish supplemental pulmonary blood flow with either a Blalock-Taussig-Thomas shunt (BTTS) or patent ductus arteriosus (PDA) stent. Patients were followed through the time of their Glenn operations. Logistic regression analysis was performed to determine optimal iBVFA cut points. Thirty-seven patients with TA or DILV with normally related great arteries were included. Sixteen had iBVFA < 1cm2/m2, with all 16 (100%) requiring either a BTTS or PDA stent to increase pulmonary blood flow before the Glenn operation. Seventeen had iBVFAs of 1 to 2cm2/m2, with 10 (59%) requiring either a BTTS or PDA stent. Nine of those 10 demonstrated flow acceleration across the BVF and/or pulmonary outflow tract. Four had iBVFA > 2cm2/m2, with only one patient (25%) requiring a BTTS. Among our cohort, an iBVFA of <1.8cm2/m2 provided sensitivity of 96% with good positive and negative predictive values (81% and 80%, respectively) for requiring intervention with a BTTS or PDA stent before the Glenn operation. An iBVFA of ≤1.8cm2/m2 on initial postnatal echocardiography is associated with the development of subpulmonary obstruction requiring intervention with a BTTS or PDA stent before the Glenn operation, with the highest risk noted in those with iBVFA of ≤1cm2/m2. Factors such as BVF flow acceleration or pulmonary outflow tract narrowing should also be considered in the decision to augment pulmonary blood flow.

Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review

<h2>Abstract</h2><h3>Background</h3> Patent ductus arteriosus (PDA) stent placement and systemic-pulmonary surgical shunt procedure can both be performed as palliation for infants with duct-dependent pulmonary circulation. The aim of this meta-analysis and literature review was to compare outcomes and study populations between the 2 methods as well as review the technical considerations and complications of PDA stenting. <h3>Methods</h3> A systematic search was conducted using the PubMed database and meta-analysis was performed. Risk ratio and mean difference were used to compare the reported outcomes of studies across patients receiving PDA stent and surgical shunt. <h3>Results</h3> In total, 1094 patients from 8 comparative observational studies were included. The PDA stent group had a lower mortality rate and a shorter hospital length of stay than the systemic-pulmonary surgical shunt group, although at the expense of increased reintervention rates. There were higher proportions of patients with single-ventricle physiology and single-source pulmonary blood flow in the surgical shunt group. <h3>Conclusions</h3> PDA stenting appears to be a noninferior or possibly superior method of palliation for duct-dependent pulmonary circulation compared with systemic-pulmonary surgical shunt, recognizing, however, that patients receiving surgical shunt more often had single-ventricle physiology or single-source pulmonary blood flow in this meta-analysis.

Favourable Short- to Mid-Term Outcome after PDA-Stenting in Duct-Dependent Pulmonary Circulation.

Background. Stenting of patent ductus arteriosus (PDA) is a minimally invasive catheter-based temporary palliative procedure that is an alternative to a surgical shunt in neonates with duct-dependent pulmonary perfusion. Methods. An observational, single-centre, cross-sectional study of patients with duct-dependent pulmonary perfusion undergoing PDA-stenting as a stage I procedure and an analysis of short- to mid-term follow-up until a subsequent surgical procedure (stage II), with a focus on the interstage course. Results. Twenty-six patients were treated with PDA-stenting at a median (IQR) age of 7 (4–10) days; 10/26 patients (38.5%) (6/10 single pulmonary perfusion) were intended for later univentricular palliation, 16/26 patients (61.5%) (13/16 single pulmonary perfusion) for biventricular repair. PDA diameter was 2.7 (1.8–3.2) mm, stent diameter 3.5 (3.5–4.0) mm. Immediate procedural success was 88.5%. The procedure was aborted, switching to immediate surgery after stent embolisation, malposition or pulmonary coarctation in three patients (each n = 1). During mid-term follow-up, one patient needed an additional surgical shunt due to severe cyanosis, while five patients underwent successful catheter re-intervention 27 (17–30) days after PDA-stenting due to pulmonary hypo- (n = 4) or hyperperfusion (n = 1). Interstage mortality was 8.6% (2/23), both in-hospital and non-procedure-related. LPA grew significantly (p = 0.06) between PDA-stenting and last follow-up prior to subsequent surgical procedure (p = 0.06). RPA Z-scores remained similar (p = 0.22). The subsequent surgical procedure was performed at a median age of 106 (76.5–125) days. Conclusions. PDA-stenting is a feasible, safe treatment option, with the need for interdisciplinary decision-making beforehand and surgical backup afterwards. It allows adequate body and pulmonary vessel growth for subsequent surgical procedures. Factors determining the individual patient’s course should be identified in larger prospective studies.

Experience of Endovascular Treatment of Pulmonary Artery Atresia

The aim. To analyze the results of the use of endovascular treatments for pulmonary artery atresia (PAA).&#x0D; Materials and methods. Treatment of this heart defect at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine with application of endovascular methods began in 2006. Since then, 138 patients were operated, 57 of them female (41.3%) and 81 (58.6%) were male. Endovascular methods were used in 23 patients, and 115 patients underwent open-heart surgery. The mean length of hospital stay was 25±16.3 days.&#x0D; Of 115 patients who underwent open-heart surgery, 62 (54%) were male and 53 (46%) were female. On the day of surgery, the mean age of these patients was 607.8±1023.7 days, mean weight was 8.8±8.1 kg. The average length of hospital stay was 26±18.6 (maximum 215, minimum 5). Of 23 patients who underwent endovascular surgery, 18 (77%) were male and 5 (23%) were female. The mean age on the day of surgery was 220.5±650.2 days, mean weight was 5.0±4.4 kg. The mean length of hospital stay was 22±5.7 days (maximum 34, minimum 4).&#x0D; In the treatment of PAA, a stepwise procedure is used, correcting part of the defect at each stage and thereby reducing the traumaticity of the operation. In our case, correction of the defect was performed on the open heart and using endovascular methods of treatment. After endovascular interventions, no fatal effects were observed. Open-heart surgery was performed in case if endovascular interventions could not be performed. The condition of such patients was usually more severe. It should also be noted that the open-heart surgery itself is a serious trauma to the body. Due to the above, postoperative period in this group of patients more often proceeded with complications. Due to more severe preoperative condition of the patients and surgical trauma, in some cases of open-heart interventions, some patients did not recover after surgery. As a result, the total mortality in the group of patients who underwent open-heart surgery was 13.0%. In addition, in 7 cases, such surgery was supplemented by the Rashkind procedure. In case of recurrent surgery after 6 months, stenting of patent ductus arteriosus was performed. Repeated surgical interventions were accompanied by the improvement of the condition and the patients were discharged from the clinic in satisfactory condition.&#x0D; Conclusions. PAA is one of the most complex congenital pathologies of the heart and main vessels, and therefore preservation of such a newborn depends on the preservation of patent ductus arteriosus. Endovascular surgery for PAA is the operation of choice that allows to prepare the patient for the next stage of treatment, including open-heart surgery. Endovascular interventions in PAA are minimally invasive, which increases the chances of patients with complicated anatomy to survive despite their serious condition on admission to the hospital.

Pulse Oximetry Error in Patients With Single-Ventricle Palliation

Pulse Oximetry Error in Patients With Single-Ventricle Palliation

Ductus Arteriosus Stenting in Neonates with Pulmonary Valve Atresia: Outcomes and Considerations

Background: Patent ductus arteriosus (PDA) stenting was invented particularly for congenital heart diseases with ductal-dependent pulmonary blood flow, and newer techniques are constantly being introduced. Objectives: In this study, we investigate the one-year results of this procedure and describe some of our periprocedural considerations. Methods: The neonates with pulmonary atresia and ventricular septal defect (VSD) who underwent PDA stenting in our center from February 2016 to December 2019 were included in this retrospective study. Spo2 and McGoon ratios were recorded before and a year after stenting and compared to each other. Results: In 26 neonates, PDA stenting was performed; 20 procedures (77%) were successful, and six procedures (23%) were unsuccessful. Two of these unsuccessful cases died during the procedure, and two of them died as a result of neonatal sepsis following the procedure. A total of 18 PDAs (70%) were accessed via the axillary artery, 6 (23%) via the femoral artery, and 2 (7%) via the antegrade inferior vena cava route. The comparison between the results before and one year after stenting revealed the increase of O2 saturation from 53.78 ± 7.35 to 84.33 ± 6.5 (P-value = 0.032) and McGoon ratio from 1.16 ± 0.25 to 1.65 ± 0.34 (P-value = 0.041). Additionally, we discussed some technical considerations of PDA stenting, including the access point, management of pulmonary artery bifurcation stenosis, stent diameter, stenting of long and tortuous PDAs, thrombosis, and anticoagulation. Conclusions: Ductal stenting increases SpO2 and McGoon ratio and could be a less-invasive option for securing pulmonary blood circulation. However, further studies are required to advance PDA stenting techniques for specific anatomical features.

Short- and medium-term outcomes for patent ductus arteriosus stenting in neonates ≤2.5 kg with duct-dependent pulmonary circulation.

Morbidity with surgical systemic-to-pulmonary artery shunting (SPS) in infants ≤2.5 kg has remained high. Patent ductus arteriosus (PDA) stenting may be a valid alternative. The objective of this study isto evaluate outcomes following PDA stenting in patients ≤2.5 kg from four large tertiary centers. Retrospective review of all neonates ≤2.5 kg with duct-dependent pulmonary circulation who underwent PDA stenting. Procedural details, pulmonary arterial growth, reinterventions, surgery type, and outcomes were assessed. PDA stents were implanted in 37 of 38 patients attempted (18 female) at a median procedural weight of 2.2 kg (interquartile range[IQR], 2-2.4 kg). Seven patients (18%) had a genetic abnormality and 16 (42%) had associated comorbidities. The median intensive care unit stay was 4 days (IQR, 2-6.75 days), and the median hospital stay was 20 days (IQR, 16-57.25). One patient required a rescue shunt procedure, with three others requiring early SPS (<30 days postprocedure). Twenty patients (54%) required reintervention with either balloon angioplasty, restenting, or both. At 6-month follow-up, right pulmonary artery growth (median z-score -1.16 to 0.01, p = 0.05) was greater than the left pulmonary artery (median z-score -0.9 to -0.64, p = 0.35). Serious adverse effects (SAEs) were seen in 18% (N = 7) of our cohort. One patient developed an SAE during planned reintervention There were no intraprocedural deaths, with one early procedure-related mortality, and three interstage mortalities not directly related to PDA stenting. PDA stenting in infants ≤2.5 kg is feasible and effective, promoting pulmonary artery growth. Reintervention rates are relatively high, though many are planned to allow for optimal growth before a definitive operation.