Background: Stenting of the ductus arteriosus as a means to establish a reliable source of pulmonary blood flow for palliation in duct dependent cyanotic congenital heart disease is a novel approach in transcatheter intervention. The advantages and disadvantages of this procedure are not yet fully understood.
Methods: In this Retrospective Cohort Study, all 47 neonates and infants younger than 3 months old were included with weight at procedure of 1.5 kg or heavier, presenting for the first time with duct-dependent congenital heart disease and underwent cardiac catheterization and angiography with the intent of stenting the PDA as first-stage palliation from January 2012 to December 2015. The detailed diagnosis was established by echocardiography. PDA stenting was performed by a qualified interventionalist already adept in doing PDA stenting using standard procedures. Data from follow-up by clinical examination, echocardiography, and repeat cardiac catheterization or cardiac CT angiogram at six months post stent implantation was obtained from the patient's medical records. Factors associated with mortality and morbidity was determined using Fisher's exact test. A p value ≤ 0.050 was considered significant.
Results: Stenting of the PDA was attempted in 47 patients. The median age at the time of the procedure was 34 ± 54.4 days and median weight was 3336 ± 893.6 grams. Majority (90%) of the patients were term neonates. The mean interval days from admission to procedure were 4.6 ± 4.5 days. Most of the patients (68.1 %) required blood transfusions during the procedure. Of the 47 patients who had attempted PDA stenting, there were 83% who had successful PDA stenting.
Seventy seven percent of them survived until discharged with improved 02 saturation post procedure. The post procedural mortality was 7% which include immediate deaths directly related to the procedure, while deaths before discharge were 15%. The periprocedural complications due to stent migration were 4%, acute thrombosis at 2%, and permanent femoral vessel damage at 20%. Patients who underwent duct re-stenting were 2% and a surgical intervention (Blalock Taussig Shunt) at 6%. There were 72% of patients who had a widely patent stent.
Conclusion: Stenting of the arterial duct offers an alternative to surgical systemic to pulmonary artery shunts. The procedure should, however, be carried out by skilled operators in a unit accustomed to dealing with children. This study recommended a thorough septic screening, since most patients in the study came in late and done as emergency cases. Elective intubation should be carried out prior to procedure for a more controlled environment, and early intervention either through surgery or intervention should be done once diagnosis is made to improve clinical outcome. In developing countries such as our's, PDA stenting is a viable option and can assist to reduce the load on overburdened surgical lists.