Objective: Ductal stent(DS) offers an alternative to Blalock Taussig shunt(BTS) in cyanotic diseases. We analyze procedural results and followup till the next palliation.
Methods: Cyanotic infants were offered DS instead of BTS. After aortogram under sedation with ketamine or general anesthesia, Prostaglandin E1 stopped, ducts were cannulated with cut pigtail catheter and coronary guidewires and entire duct stented with 3.5 or 4 mm (former in infants under 2.5kg) coronary stents. Associated procedures included pulmonary valve perforation and balloon dilatation. Subsequent care included 48 hours heparinization, aspirin and clopidogrel, monthly monitoring for reappearance of hypoxia.
Results: 19 patients aged 3days to 1year had DS, weight ranged 2.1-6 kg. 17 were neonates. Pulmonary valve perforation was done in 4 patients, others had DS alone. Duct anatomy was vertical in 8 patients, tortuous in 7, contralateral in 3 and bilateral in one. The mean oxygenation improved from 58% to 84%, mean hospital stay was 3.1+/-0.8 days. There was one procedural death due to acute stent thrombosis when guidewire was removed; two hospital deaths due to pulmonary overcirculation, hypotension and myocardial failure, one late sudden death at home. Next palliation in 15 patients included bidirectional glenn surgery in 5, conduit repair of Fallot’s tetralogy in 6, BTS in one. The mean duration till next palliation was 4.6+/-3.1 months (2 weeks to 11 months). Four patients who had balloon pulmonary dilatation had no further surgery.
Conclusions: DS offers a less morbid alternative to BTS in duct dependent patients; however with considerable procedural and interstage mortality.