[III-JCKAP7-1-4] Stent strut dilation in branch pulmonary stenosis during stenting of arterial duct in infants with duct dependent with duct dependent pulmonary circulation
Keywords:pulmonary atresia, stenting of arterial duct, branch pulmonary artery stenosis
Stenting of arterial duct in infant with duct dependent circulation in the presence of branch pulmonary artery stenosis is relatively contraindicated. However, opening of the stent struts to the stenosed branch pulmonary artery may establish good flow and allows growth of pulmonary artery for future surgical procedure. We have performed arterial duct stenting in the presence of branch pulmonary artery stenosis and opened the stent struts to the stenosed pulmonary artery. After deploying the stent, a check angiogram was performed to demonstrate the stenosis. An additional 0.014” coronary guide wire was manipulated to cross the stenosed branch pulmonary artery. A 2.0- or 2.5-mm diameter short length (8-13mm) coronary balloons were used to dilate the stent struts. A confirmatory check angiogram was done to see the adequacy of flow in the stenosed vessel.A total of 28 (male: 17) patients were undergone the procedure. The median age and weight were 24.6 (range 2-94) days and 2.8 (range 1.8-5) kg respectively. 23 patients underwent stent strut dilation after ductus arteriosus stenting. Struts to left pulmonary artery was opened in 16 (70%) cases and right pulmonary artery in 7 (30%) cases. The baseline saturation (%) of 65.8 7.4 improved to 88 2.8 after the successful strut dilatation. Angiographic pulmonary flow was established in all cases. DA stenting was deferred in 1 patient due to good sized main pulmonary artery and insignificant branch PA stenosis. This patient underwent neonatal surgical correction. Stent strut dilatation could not be done in 4 cases due to unfavorable anatomy after DA stenting. One patient had acute stent thrombosis and died in the hospital. Two patients died during follow up presumed to be due to stent occlusion during febrile illness and gastroenteritis. Twenty patients underwent cardiac surgery and were on regular follow-up.Conclusions: Strut dilatation in branch pulmonary artery stenosis appears to be feasible to establish pulmonary blood flow and growth of stenosed pulmonary artery.