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Patent Ductus Arteriosus Stenting in Complex Congenital Heart Disease: Early and Midterm Results for a Single-Center Experience at Children Hospital, Mansoura, Egypt.
MedLine Citation:
PMID:  23239311     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
This study aimed to assess the efficacy and outcome of transcatheter ductus arteriosus stenting in newborns and infants with ductal-dependent or decreased pulmonary circulation. Between September 2009 and December 2011, 33 newborns and infants were subjected to patent ductus arteriosus (PDA) stenting as an alternative to a surgical shunt. Of the 33 patients, 20 had pulmonary atresia (PA) with a ventricular septal defect, 4 had PA with an intact ventricular septum, 5 had PA with a double-outlet right ventricle, and 4 had critical pulmonary stenosis. The McGoon ratio ranged from 0.8 to 1.9 (median 1.27). The ages of the patients ranged from 3 to 56 days, and their weight ranged from 2.7 to 4.1 kg. The oxygen saturation ranged from 45 to 61 %, and the pH ranged from 7.13 to 7.27. Premounted coronary stents with diameters of 3, 3.5, and 4 mm were used to cover the whole length of the ductus. The PDA was tortuous in 23 patients and straight in 10 patients. The mean ductal length was 12.2 ± 3.7 mm (range 7.8-23 mm). The mean stent length was 14.3 ± 3.4 mm (range, 8-23 mm), and the mean narrowest ductal diameter was 1.9 ± 0.6 mm (range, 0.8-2.9 mm). Immediately after the procedure, the oxygen saturation was increased from a mean of 75.1 ± 13.2-91.5 ± 6.3 % (p < 0.0001), and the PDA diameter was increased from a mean of 1.9 ± 0.6-4.3 ± 0.8 mm (p < 0.0001). Stent redilation was necessary in two patients 8 days after the procedure, and their oxygen saturation increased 79-88 %. The mean fluoroscopy time was 39.4 ± 15.5 min. Stent dislocation to the left main pulmonary artery was seen in one patient, with another stent placed in the arterial duct. No procedure-related mortality occurred. Two neonates died a few days after the procedure due to sepsis related to the procedure. The surviving patients were discharged home 8-30 days (median, 9.5 days) after the procedure. Stent patency was achieved for 8-550 days. The McGoon ratio increased and ranged from 1.6 to 2.8 (median, 1.87) before the surgical intervention. Glenn anastomosis was possible for 18 patients at the age of 6-8 months. Nine patients experienced worsening of cyanosis about 4 months after stent placemen. Six of these patients required a Blalock-Taussig shunt, whereas stent dilation was possible for the remaining three patients. Four patients died of severe dehydration while awaiting a Glenn shunt. The findings show that PDA stenting can be a good alternative to surgery for initial palliation, especially in infants who will need multiple surgeries. It is safe and feasible but its efficacy gradually lessens after 6 months due to intrastent endothelial hyperplasia.
Authors:
Mohamed Matter; Hala Almarsafawey; Mona Hafez; Gehan Attia; Mohamed-Magdy Abuelkheir
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-13
Journal Detail:
Title:  Pediatric cardiology     Volume:  -     ISSN:  1432-1971     ISO Abbreviation:  Pediatr Cardiol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003849     Medline TA:  Pediatr Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Pediatric Cardiology Unit, Mansoura University Children's Hospital, Mansoura, 35516, Egypt, mkmatter72@yahoo.com.
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