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Bahaidarah S, Al-Ata J, Alkhushi N, Azhar A, Zaher Z, Alnahdi B, Abdelsalam M, Elakaby A, Dohain A, Abdelmohsen G. Outcome of ductus arteriosus stenting including vertical tubular and convoluted tortuous ducts with emphasis on technical considerations. Egypt Heart J 2021; 73:83. [PMID: 34542737 PMCID: PMC8452800 DOI: 10.1186/s43044-021-00210-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background Ductal stenting is the preferred method of securing adequate pulmonary blood flow in patients with duct-dependent pulmonary circulation. The main limitation in most centers is the difficult vertical tubular or convoluted ducts that represent real challenges to interventional pediatric cardiologists. We present our experience in patent ductus arteriosus (PDA) stenting with some technical tips to overcome difficulties, especially in stenting tortuous or long tubular ducts. This study was conducted on all patients with cyanotic congenital heart disease who underwent PDA stenting between January 2011 and December 2018. Results We attempted to stent the PDA in 43 patients, with a success rate of 93% (40 patients) and only one procedural mortality. There was also one stent migration that needed to be treated with urgent surgery. Three-fourths of the patients had difficult ductal morphology and origin. One stent was used to cover the PDA in 27 patients (62.8%), two stents were used in 13 (30.2%), and three stents were used in 2 patients (4.6%). In-stent stenosis rate was 12.5% (5 patients) and the development of progressive left pulmonary artery stenosis was seen in two patients (5%). Pulmonary artery growth was adequate in all patients. Conclusions PDA stenting is an effective method of palliation for patients with duct-dependent pulmonary circulation. It has low morbidity and mortality rates. Stenting difficult ducts have become more feasible with evolving materials and techniques. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-021-00210-4.
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Affiliation(s)
- Saud Bahaidarah
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Jameel Al-Ata
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Naif Alkhushi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmad Azhar
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Zaher Zaher
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Bayan Alnahdi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia
| | - Mohamed Abdelsalam
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia.,Cardiology Department, Benha University, Benha, Egypt
| | - Ahmed Elakaby
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia.,Paediatric Department, Al-Azhar University, Cairo, Egypt
| | - Ahmed Dohain
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia.,Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, 11562, Egypt.,Paediatric Cardiology Division, Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt
| | - Gaser Abdelmohsen
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P. O. Box 80215, Jeddah, 21589, Saudi Arabia. .,Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, 11562, Egypt.
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Haas NA, Fernandez-Rodriguez S, Dalla Pozza R, Fischer M, Ulrich S, Jakob A, Lehner A. Microcatheter-assisted stenting of the tortuous vertical ductus arteriosus via femoral access in a duct-dependent pulmonary circulation. Int J Cardiol 2019; 285:103-107. [PMID: 30851992 DOI: 10.1016/j.ijcard.2019.01.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/24/2018] [Accepted: 01/16/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Stenting of the patent ductus arteriosus (PDA) has been accepted as alternative option to surgical shunting to enable additional pulmonary blood flow or for palliation of patients with a truly duct-dependent pulmonary circulation. The procedure can be challenging given the variable and often tortuous anatomy of the PDA and various technical approaches are reported. OBJECTIVE To report an alternative technique to treat tortuous ducts with microcatheter assistance and by transfemoral approach. METHODS We applied this technique of PDA stenting in 5 consecutive patients (4/5 age < 1 week, weight 2,7-3,2 kg; 1/5 re-do PDA stenting at 6,5 month and 5,9 kg). A soft coronary guidewire was advanced by microcatheter assistance into the branch pulmonary arteries and thereafter replaced by an extrastiff guidewire to enable the placement of long coronary stents. RESULTS Successful PDA stenting with this stepwise approach and with femoral access only could be achieved in all patients (n = 5/5). A single stent was used in 2 patients (one with re-do stenting and previous stents). 3/5 patients had 2 stents implanted by telescopic technique. Stent sizes used were 4,5 × 15 mm (n = 2) and 4,5 × 18 mm (n = 6). No guide wire or stent dislodgement appeared through all procedures with microcatheter assistance. CONCLUSIONS This technique enables PDA stenting via transfemoral approach in complex and tortuous ducts and thereby offers an attractive addition to the interventional management of truly duct-dependent pulmonary circulation.
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Affiliation(s)
- N A Haas
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany.
| | - S Fernandez-Rodriguez
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - R Dalla Pozza
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - M Fischer
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - S Ulrich
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - A Jakob
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
| | - A Lehner
- Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany
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Raval A, Thakkar B, Madan T, Oswal N, Garg R, Umalkar R, Shah K, Maheriya B. Ductus arteriosus stenting: A promising percutaneous palliation in patients with duct-dependent pulmonary circulation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Raval A, Thakkar B, Madan T, Oswal N, Garg R, Umalkar R, Shah K, Maheriya B. Ductus arteriosus stenting: A promising percutaneous palliation in patients with duct-dependent pulmonary circulation. Rev Port Cardiol 2016; 35:583-592. [PMID: 27746039 DOI: 10.1016/j.repc.2016.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/25/2016] [Accepted: 06/06/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We aimed to study the feasibility and outcomes of ductal stenting in patients with duct-dependent pulmonary blood flow (PBF). METHODS Duct-dependent hypoxic patients with confluent pulmonary artery (PA) branches were enrolled for ductal stenting and followed regularly. RESULTS Sixty patients, with a median age of 12 (1-1095) days and weight of 2.8 (2.2-8.9) kg, were enrolled. Median right PA (RPA) and left PA (LPA) Z-scores were -1.23 (-10.54 to 2.81) and -0.96 (-8.03 to 3.0), respectively. Mean narrowest ductal diameter was 1.73±0.57 mm and length was 12.78±3.32 mm. Sixty-four stents with mean diameter of 4.21±0.32 mm and length of 14.34±3.44 mm were deployed in 59 patients. The procedure was unsuccessful in one. Post-stenting mean oxygen saturation (SO2) increased significantly from baseline of 68.88±7.47% to 90.43±6.04% (p<0001). Complications included pulmonary edema in one patient and acute stent occlusion in another. At a median follow-up of eight (2-14) months, mean SO2 (80.04±7.54%) was significantly higher than baseline (p<0.0001). Median RPA and LPA Z-scores, 0.56 (-2.89 to 3.29) and -0.02 (-2.81 to 3.86), respectively, were significantly higher than baseline. Six patients required re-interventions (shunt in three and angioplasty in three). Six patients died, three due to sepsis and another three with worsened cyanosis due to impaired PBF, probably due to ductal occlusion. CONCLUSION Ductal stenting is an effective palliation in patients with duct-dependent PBF. It maintains adequate SO2 and promotes balanced PA growth at mid-term follow-up.
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Affiliation(s)
- Abhishek Raval
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India.
| | - Bhavesh Thakkar
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India
| | - Tarun Madan
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India
| | - Nilesh Oswal
- Paediatric Cardiology and Cardiothoracic Department, Royal Brompton and Harefield Hospital Foundation NHS Trust, London, United Kingdom
| | - Rajiv Garg
- Delhi Heart Institute and Multispeciality Hospital, Bathinda, India
| | - Rhshikesh Umalkar
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India
| | - Komal Shah
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India
| | - Bhumika Maheriya
- UN Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India
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