Percutaneous transluminal angioplasty of stenotic ductus arteriosus

Stenting the patent ductus arteriosus in duct-dependent pulmonary circulation: techniques, complications and follow-up issues

Maintaining ductal patency in duct-dependent congenital heart lesions by implantation of coronary stents is an alternative to systemic pulmonary shunt in selected cases and lesions with suitable anatomy. This article focuses on the procedure as the initial palliation in duct-dependent pulmonary circulation, its associated pitfalls and complications. A good understanding of the diverse duct morphology is paramount prior to stenting of the ductus. Long tortuous duct, insufficiently constricted ductus at the pulmonary end and ductus with associated branch pulmonary artery stenosis at the site of insertion are not suitable for stenting. Durability of palliation is generally inferior to a surgical shunt and this may dictate earlier definitive surgical repair. Acceleration of branch pulmonary artery stenosis in certain ductal morphology limits its general applicability. Bioabsorbable and biodegradable stents may offer some solution to this problem.

Balloon angioplasty for ductus arteriosus in infant with ductal origin of the left pulmonary artery: combination with nitrogen inhalation therapy

An infant with truncus arteriosus (Van Praagh A3; isolated left pulmonary artery (LPA) and ductal origin of the LPA) had an extremely stenotic ductus arteriosus (DA) and the LPA could not be demonstrated. As a salvage operation, balloon angioplasty was performed for the stenotic DA at 8 days of age. The minimum lumen diameter of the DA increased from 0.7 to 2.7 mm. After the procedure, the LPA tree was well demonstrated and total pulmonary blood flow increased. Nitrogen inhalation was begun with a nasal positive airway pressure system in order to regulate pulmonary blood flow. Repeat balloon angioplasty was performed at 33 days of age for the restenosed DA. The infant's general condition was stabilized until undergoing pulmonary artery reconstruction and modified Blalock-Taussig shunt at 4 months of age, and definitive repair at 11 months of age. The combination of balloon angioplasty and nitrogen inhalation therapy enabled simultaneous growth of the LPA tree and regulation of total pulmonary blood flow, which could be a useful strategy for complex congenital heart diseases with unbalanced pulmonary blood flow.

Transductal balloon angioplasty for coarctation of the aorta in the neonate: preliminary observations

Transductal balloon angioplasty for coarctation of the aorta is described wherein the balloon dilatation catheter is positioned across the coarctation after having passed into the descending aorta from the main pulmonary artery via a patient ductus arteriosus. This procedure was performed in two neonates with excellent immediate clinical results and objective improvement in the pressure gradient. The mechanism of relief of obstruction appears to be ductal dilatation, which allows bypassing the posterolateral shelf of aortic coarctation. This technique is recommended in neonatal coarctations with open ductus arteriosus, especially if the femoral artery cannot be catheterized for performing conventional transfermoral balloon coarctation angioplasty.