Background and aims: Ductal stenting in neonates and infants with pulmonary atresia-variants potentially avoids the need for a surgical shunt. We report a multi-center experience with this approach.
Patients and methods: 31 consecutive infants (17 female) from 3 centers, catheterised on an intention to treat are presented. The demographic data were as follows: age 3 to 120 days; weight 2.2 to 4.0kg. The ductal morphology was horizontal and straight (n=22), tortuous (n=5) and vertical (n=4). Stenting was performed as an adjunct to RF perforation of the pulmonary valve in 16 patients. Prostaglandin E was discontinued 6 hours prior to the procedure in 23 infants.
Results: In 6 patients, a stent was not implanted for the following reasons (failure to enter the duct n=4); tortuous duct with concomitant stenosis of a branch PA (n=2). In the remainder, stents ranging from 3.5 to 4.5mm in diameter of varying lengths were implanted (retrogradely in 14, anterogradely in 11; 2 stents in series in 2 patients). The procedure was uncomplicated in all; 1 infant in whom the initial stent did not cover the entire duct required a second stent at an interval of 3 days. Following stent implantation, the systemic saturation at rest ranged from 75 to 88%. The duration of hospital stay ranged from 1 to 66 days. Patients were discharged from hospital on aspirin 5mg/kg/day.
Conclusions: Despite a learning curve, ductal stenting is relatively straightforward and provides adequate medium-term palliation. It is of particular importance in centers with limited surgical backup.