Staged Hybrid Approach for Ductal Origin of the Pulmonary Artery in a Low Birth Weight Neonate

Abstract

Early recruitment of a discontinuous branch pulmonary artery will give the best long-term outcome for congenitally disconnected pulmonary arteries. This may be achieved using a staged approach. Even in low birth weight neonates, a hybrid approach with the first stage consisting of transcervical (via the common carotid artery) patent ductus arteriosus stenting can be performed to recruit the pulmonary artery where conventional treatment strategies may not be feasible or may be associated with higher risk.

Branch Pulmonary Artery Jailing During Patent Ductus Arteriosus Stenting: Recruitment and Immediate Outcomes

“…Of the 50 patients with completed PDA stent without jailing, 2 had congenitally disconnected branch PAs, of which one neonate succumbed to Pseudomonas sepsis and necrotizing enterocolitis 18 days postprocedure and the other was unifocalized successfully. 5 Of the remaining 48 patients with confluent branch PA (with or without origin stenosis), there were two mortalities. The first child was a case of pulmonary atresia with intact ventricular septum with bipartite hypoplastic right ventricle and moderate atrial septal defect (ASD).…”

“…The CCA approach technique described by Azzolina et al 4 was followed and we have described this previously. 5 We do not prefer percutaneous arterial puncture for sheath access for CCA.…”

Hybrid Approach for Embolized Right Ventricular Outflow Tract Stent

“…An arteriotomy is made and a 7F sheath is inserted, purse strings are snared, and the sheath is secured to the skin using silk sutures after deairing; the procedure has been explained in the past. 6,7 A 5F multipurpose catheter is passed, through which a 0.018″ straight Terumo wire (Terumo Interventional Systems, Somerset, New Jersey, USA) is passed down and through the stent in the aorta. Over this wire, a 10 mm × 3 cm TyShak balloon (B. Braun Interventional Systems Inc. Bethlehem, PA, USA) is passed and inflated beyond the stent.…”

Effectiveness of stenting and subsequent re‐implantation of disconnected pulmonary artery to restore the pulmonary hemodynamics

“…Isolated disconnected pulmonary artery (PA), also known as ductal origin of PA, is a rare condition with an estimated incidence of approximately 1:200 000. 1 Flow to a disconnected PA usually originates from a systemic artery through the patent ductus arteriosus (PDA). Although early surgical treatment is mandatory to support disconnected PA growth, this branch is small with insufficient blood flow, which makes it unsuitable for surgical correction.…”

“…Isolated disconnected pulmonary artery (PA), also known as ductal origin of PA, is a rare condition with an estimated incidence of approximately 1:200 000 1 . Flow to a disconnected PA usually originates from a systemic artery through the patent ductus arteriosus (PDA).…”