ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Evaluation of the efficacy of ductus arteriosus stenting in neonates and infants with severe cyanosis until the later stage palliative surgery or total repair time
Abdullah Erdem1, Ali Rıza Karacı2, Turkay Sarıtaş1, Celal Akdeniz1, Halil Demir1, Ahmet Şaşmazel2, Ahmet Çelebi1
1Departments of Pediatric Cardiology, Siyami Ersek Training and Research Hospital, İstanbul
2Departments of Cardiovascular Surgery, Siyami Ersek Training and Research Hospital, İstanbul
DOI : 10.5606/tgkdc.dergisi.2011.011
Background: In this study, we aimed to assess the efficacy and outcome of transcatheter ductus arteriosus stenting in newborns and infants with ductal-dependent or decreased pulmonary circulation.

Methods: Between July 2004 and January 2009, 45 patients with ductus-dependent or decreased pulmonary circulation underwent cardiac catheterization for stent implantation. Forty-seven stents in total were implanted in 42 (93.3%) of these 45 patients. The mean age at the time of the procedure was 66 days (3 days to 1.8 years) and mean weight was 4.4±2.1 kg (2-13.2). Premounted coronary stents of 3, 3.5, and 4 mm in diameter were used to cover the whole length of the ductus.

Results: The stenting procedure was successfully completed in all 42 patients. There was no procedure related death. The mean ductal length was 13.2±3.8 mm (7.8-23 ) and the mean stent length was 13.9±3.8 mm (8-23). Mean arterial oxygen saturation before stent implantation was 66.0% ±8.1 (42-75) and increased to 85.7%±4.2 (75-95) after stenting. During a mean follow-up of 34.5±14.4 months (12-54), there was a significant reduction in pulse oxygen saturation six months after the procedure (78.8%±8.5; p<0.05). Control cardiac catheterization was performed in 25 (59%) patients at a mean of 8.1 months (2-18) after the initial implantation. Twelve patients (28%) underwent a successful redilatation of the stent with an increase in mean oxygen saturation of 13%±3.6 (8-20). Fourteen of 42 patients have undergone successful biventricular repair and bidirectional cavopulmonary shunt (Glenn operation) was performed in 16. Four patients underwent elective unifocalization of the pulmonary arteries and modified Blalock-Taussig shunt. Of the patients undergoing Glenn operation or total repair surgery, 12 (40%) patients had pulmonary arterioplasty. Four patients were totally cured after stent implantation of the ductus combined with valvotomy and/or valvuloplasty. The remaining four patients died on follow-up.

Conclusion: Stent implantation of ductus arteriosus can be a good alternative to surgery for initial palliation in severely cyanotic newborns and infants until the latter stage palliative surgery or total repair. It is safe and feasible however its efficacy gradually reduces after six months. In selected patients like critical pulmonary stenosis or pulmonary atresia-intact ventricular septum with favorable anatomy it may provide a definitive cure.

Keywords : Cyanotic infants and newborn; ductal stenting; surgery
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