Ductal Stent Implantation in Tetralogy of Fallot with Aortic Arch Abnormality

Abstract

Stenting of patent ductus arteriosus is an alternative to palliative cardiac surgery in new-T etralogy of Fallot (TOF) is one of the most common forms of cyanotic con genital heart disease. It occurs in 3 of every 10,000 live births and constitutes 7% to 10% of all congenital heart defects.1 Approximately 6% to 21% of all TOF patients and 20% of patients with aortic arch abnormality have chromosome 22q11 deletion syndrome. However, the combination of TOF and double aortic arch is rarely seen in cases of 22q11 deletion. 24The initial presentation of the patient with TOF depends on the degree of right ven tricular outflow tract (RVOT) obstruction. Most often, cyanosis is mild at birth and gradually worsens with age, as hypertrophy of the right ventricular (RV) infundibu lum progressively obstructs the RVOT. In some cases, severe cyanosis is seen at birth or shortly thereafter.5 Diagnosis of TOF in the neonate before closure of the ductus arteriosus presents the challenging clinical necessity of predicting the degree of pulmo nary blood flow once the ductus has undergone spontaneous closure. Neonates with critically restricted antegrade flow and ductdependent circulation must be started on prostaglandin E 1 and considered for aortopulmonaryshunt adjustment or total repair. 6 Despite advances in surgical repair techniques of cyanotic congenital heart disease and a trend toward early primary repair, firststage palliation via the surgical creation of an aortopulmonary shunt remains, in developing countries, an important option for the treatment of ductdependent cyanotic congenital heart disease. Yet shunt surgery during the neonatal period is an important cause of morbidity and death.In neonatal patients, percutaneous stenting of the patent ductus arteriosus (PDA) is an alternative to surgical palliation, 710 but its use in cases of aortic arch abnormality presents a major technical challenge. Herein, we describe a ductalstent implantation procedure in a newborn with TOF, aortic arch abnormality, and 22q11 deletion syn drome. Case ReportAn 18dayold male infant was referred to our hospital with cyanosis and heart mur mur. The patient had dysmorphic facial features, a length of 50 cm, a weight of 3.2 kg,

The outcome of percutaneous stent implantation in congenital heart disease: experience of a single institute

“…Stent implantation in a patent ductus arteriosus is an alternative to surgical palliation in neonatal patients with ductal-dependent pulmonary circulation. 14 15) Optimal diameter of stented ductus was not established, and one of our patients showed significant pulmonary overflow after 5-mm stent, and needed a transcatheter closure of stented ductus with an Amplatzer vascular plug II (St. Jude Medical, St. Paul, NN, USA) in a month after confirming adequate right ventricle as a pulmonary pump. We supposed a 4-mm stent would be an optimal size for ductal stenting in PA IVS.…”

Characterization of the cardiogenesis in embryos of a Gse-1tm-1a(EUCOMM)Wtsi mouse line

“…Ductal contraction coerces the blood flow to enter pulmonary circulation. As a result, oxygen saturation augments (Connor and Thiagarajan 2007;Vogel et al 2010;Yun 2011;Tola et al 2015). In addition, the pulmonary vasculary resistance decreases, which leads to an increase in pulmonary blood flow.…”