Stenting the neonatal arterial duct in duct-dependent pulmonary circulation: new techniques, better results.

Abstract

The goal of this study was to assess a new approach to stent the arterial duct in neonates with a duct-dependent pulmonary circulation. Previous attempts to stent the neonatal arterial duct were unsatisfactory. Learning from these failures, we speculated that covering the complete length of the duct with current low-profile stents might avoid previous problems. Ten neonates with duct-dependent pulmonary circulations through a short straight duct were treated with stent implantation. The duct was crossed with an atraumatic 0.014-inch wire. A low-profile premounted coronary stent (outer diameter <4F, length 13 to 24 mm, diameter 3.0 to 4.0 mm) was positioned within the duct, not protected by a sheath; care was taken to cover the complete length of the duct from the aortaductal junction until well within the pulmonary trunk. All stents could safely be deployed with adequate pulmonary flow at early- and medium-term follow-up. There were no procedure-related complications; one patient died early from sepsis. All patients had adequate relief of cyanosis for at least three to four months. During follow-up, the pulmonary vasculature bed had grown without distortion. Acute occlusion of a stented duct was not observed. Ductal flow progressively decreased slowly over several months by luminal narrowing, until the stented duct had either become redundant or was dilated/restented or until elective staged surgery was performed. With current technology, complete stenting of a short straight duct is a safe and effective palliation, allowing adequate growth of the pulmonary arteries.