Outcome of ductus arteriosus stenting including vertical tubular and convoluted tortuous ducts with emphasis on technical considerations

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.

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

“…However, this assumption has been challenged by recent studies that demonstrated successful stenting for a variety of morphologies. 25,31,32 Technical considerations are important in these cases of convoluted ducts or those with difficult origin. Some investigators prefer deploying multiple overlapping stents to ensure full coverage in tackling a tortuous PDA, 31 whereas others prefer to use 1 long stent.…”

“…25,31,32 Technical considerations are important in these cases of convoluted ducts or those with difficult origin. Some investigators prefer deploying multiple overlapping stents to ensure full coverage in tackling a tortuous PDA, 31 whereas others prefer to use 1 long stent. 13 However, both stress the importance of covering both ends of the PDA and not leaving a portion unstented.…”

“…It has also been noted that straightening the PDA by crossing the main pulmonary artery stump and then deflecting it back to the branch pulmonary artery, instead of crossing directly from the PDA to the branch pulmonary artery, can increase the chances of success. 31 Some interventionists have also found it helpful to place a nasogastric tube before stent insertion to aid in the measurement of PDA and serve as a landmark for stent deployment, 32 and others have successfully navigated complex ductal turns using a microcatheter. 8,33 To standardize terminology and track stenting outcomes according to PDA morphology, Qureshi et al 25 devised a "tortuosity index" using the following classification scheme: type I (straight), type II (1 turn), and type III (multiple turns).…”

“…Therefore, there has been a trend toward the increased use of drug-eluting stents, although many institutions continue to use bare-metal stents owing to the lack of robust data regarding drugeluting stent safety. 13,18,20,31,38 Rapamycin-eluting stents have been shown to prolong ductal patency in piglets, although this effect decreases with time. 39,45 However, some concern remains over the potential immunosuppressive effects of drug-eluting stents.…”

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

“…Some studies described procedural considerations and explained their techniques. The precise attention to detail of these techniques and tips and tricks is critical for ensuring the greater success of ductus arteriosus stenting (1,7).…”