Pre-procedural CT imaging aids neonatal PDA stenting for ductal-dependent pulmonary blood flow with reduction in overall procedural morbidity

Abstract

Patent ductus arteriosus stenting for ductal-dependent pulmonary blood flow is a technically challenging neonatal procedure to maintain a stable pulmonary circulation. Pre-procedural computed tomography imaging aids in outlining ductal origin, insertion, size, course and curvature. Computed tomography imaging may add value to procedural outcomes and reduce overall procedural morbidity in neonatal patent ductus arteriosus stenting. We conducted a single centre retrospective chart review of neonates with ductal-dependent pulmonary blood flow who underwent patent ductus arteriosus stenting between January 1, 2014 and June 31, 2020. We compared patients variables between patients who underwent pre-procedural computed tomography imaging to those who did not. A total of 64 patients were referred for patent ductus arteriosus stenting with 33 (52%) obtaining pre-procedural computed tomography imaging. Average age [19 days; range 1–242 days (p = 0.85)] and weight [3.3 kg (range 2.2–6.0 kg; p = 0.19)] was not significantly different between the groups. A diagnosis of pulmonary atresia was made in 42 out of 64 (66%) patients prior to patent ductus arteriosus stenting. The cohort with pre-intervention computed tomography imaging had a significant reduction in the total number of access sites (1.2 versus 1.5; p = 0.03), contrast needed (5.9 versus 8.2 ml/kg; p = 0.008), fluoroscopy (20.7 versus 38.8 minutes; p = 0.02) and procedural time (83.4–128.4 minutes; p = 0.002) for the intervention. There was no significant difference in radiation burden between the groups (p = 0.35). Pre-procedural computed tomography imaging adds value by aiding interventional planning for neonatal patent ductus arteriosus stenting. A statistically significant reduction in the number of access sites, contrast exposure, as well as fluoroscopic and procedural time was noted without significantly increasing the cumulative radiation burden.

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

“…In our center, CA or FA/FV approaches have similar high procedural success rates due to careful preprocedural echocardiography assessment to determine what access should be taken. If echocardiography visualization is not good enough and we doubt the PDA anatomy, a computed tomography scan would add value in outlining ductal origin, insertion, size, course and curvature [ 9 ].…”

“…The relatively shorter fluoroscopy time and procedural duration in the CA approach also proved that the CA approach is effective and efficient when PDA anatomy is favourable. [ 1 , 8 , 9 ]…”

Role of Cross-Sectional Imaging in Pediatric Interventional Cardiac Catheterization

“…A biplane overlay example (Siemens bi-plane system (Siemens Healthineers, Munich, Germany) is depicted in Figure 19 [13]. Overlay fusion has demonstrated a reduction in overall radiation burden [8,9].…”

“…Figure 9. Additional example of pre-procedural CT imaging (A) aiding with access site selection for successful PDA stenting (B,C) via the left axillary artery (LAA) to the left subclavian artery (LSCA).Revised from ref[9].…”