Compression of the left mainstem bronchus by patent ductus arteriosus in neonates under consideration for ductal stenting

Abstract

Stent angioplasty of patent ductus arteriosus has been shown to be a viable alternative to operative shunt placement in cyanotic neonates. With broader implementation of this strategy, novel complications are bound to arise. We present a series of cases evaluated for ductal stent angioplasty in which a dilated and torturous ductus arteriosus compressed the left mainstem bronchus. After reviewing our recent experience with ductal stenting and isolated Blalock-Taussig shunts, our best estimate of the incidence of bronchial compression by the dilated ductus is 4.6% (3/64, 95% confidence interval 1.0-12.9%). Awareness of the airway and other nonvascular contents of the thorax is an important consideration prior to ductal stenting.

Stenting of the Patent Ductus Arteriosus: A Meta-analysis and Literature Review

“…6,34 Bronchial compression by a stented duct has also been considered a theoretical complication, especially if the patient has evidence of preexisting bronchial compression from a large and ectatic PDA. 61,62 However, stenting may actually improve bronchial compression by leading to PDA shrinkage, straightening, and lateralization 63 ; therefore, bronchial compression should not necessarily be considered a contraindication to stenting. 13 One of the most common late complications, and a significant driver behind reintervention rates, is neointimal proliferation and resulting stenosis of the stent.…”

External compression of left main bronchus by a large patent ductus arteriosus: a case report

“…Actual incidence of main bronchial compression caused by the dilated patent ductus arteriosus has not been clearly reported in the literature. Smith et al 4 reported that this incidence should be about 4.6%. Patent ductus arteriosus stenting can be used as an alternative to palliative shunt operation in cyanotic newborns.…”

Airway compression: a rare but serious complication following stenting of the patent ductus arteriosus

“…Airway proximity to the duct should be noted and although this would not necessarily preclude stenting, vigilance is required during follow-up. In a recent single-centre study, dilated and tortuous ductus arteriosus compressing the left mainstem bronchus was found in 4.6% of cases (3/64) being evaluated for ductal stenting or mBT shunt [11]. Diagnosis of airway compression was made following CT and bronchoscopy.…”