Stenting of the ductus arteriosus for ductal-dependent pulmonary blood flow-current techniques and procedural considerations

Aggarwal, Varun; Petit, Christopher J.; Glatz, Andrew C.; Goldstein, Bryan H.; Qureshi, Athar M.

doi:10.1111/chd.12709

Cited by 43 publications

(54 citation statements)

References 25 publications

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“…9 Furthermore, there are centers, where in the presence of branch PA stenosis, intentional jailing of the stenosed vessel with strut dilatation/stenting is practiced with satisfactory outcomes. 9,11 In our series, the commonest manifestation of branch PA jailing was hypoxia, which was due to differential PA blood flow and ventilation-perfusion (V/Q) mismatch (Figure 9). Jailed branch PA can result in stent thrombosis due to sluggish flow, especially when branch PA is severely hypoplastic.…”

Section: Discussionmentioning

confidence: 80%

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

Prabhu

Joshi

Mehra

et al. 2021

World J Pediatr Congenit Heart Surg

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Background: Branch pulmonary artery (PA) occlusion during patent ductus arteriosus (PDA) stenting procedure is the main reason why branch PA origin stenosis was considered as a contraindication for PDA stenting. This study was designed to assess the incidence of branch PA jailing during PDA stenting for cyanotics with duct-dependent pulmonary circulation and its immediate outcome. Methods: All the completed PDA stenting patients in our hospital between April 2017 and June 2019 were retrospectively analyzed for branch PA jailing and its outcome. Results: Of 63 completed PDA stenting, there was branch PA jailing in 13 (20.6%) patients, all successfully recruited either by strut dilatation or by surgery. The median duration of ventilation was 16 (interquartile range [IQR]: 8-22) hours for jailed patients and 17.5 (IQR: 5.25-34.25) hours for nonjailed patients ( P = .978). Median intensive care unit [ICU] stay was 69 (IQR: 47.75-96) hours for jailed patients and 79.5 (IQR: 66.75-135.25) hours for nonjailed patients ( P = .394). Procedural mortality was 1 (7.6%) for jailed patients and 3 (6%) for nonjailed patients. Since all the jailed pulmonary arteries were recruited, there was proportionate growth of branch PA till the most recent follow-up. Conclusion: Jailing of branch PA does not increase the ventilation duration, ICU stay, or mortality risk if recruited immediately. Proportionate growth of branch PAs can be achieved in spite of jailing, if addressed aggressively. Branch PA stenosis should not be considered as a contraindication for PDA stenting.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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

Prabhu

Joshi

Mehra

et al. 2021

World J Pediatr Congenit Heart Surg

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“…Balloon angioplasty alone will likely not provide long lasting patency of the ductus venosus and therefore we decided to proceed with stent implantation. With the experience of using drug eluting stents in infants demonstrating improved long‐term patency in the ductus arteriosus and pulmonary veins, 11‐13 we decided to proceed with the use of a 5 × 18 mm Resolute Onyx® (Medtronic) Zotarolimus‐eluting stent. We aimed for complete relief of portal hypertension so as to avoid recurrence of oesophageal variceal bleed and need for recurrent abdominal paracentesis.…”

Section: Discussionmentioning

confidence: 99%

Stenting of ductus venosus as a palliation for portal hypertension because of neonatal cirrhosis

Brown

Bhatt

Salunke

et al. 2022

Liver International

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Portal hypertension because of liver cirrhosis is a significant cause of morbidity and mortality. Treatment options in these patients include liver transplant, symptomatic treatment of oesophageal varices via endoscopic treatment and symptomatic management of ascites. Portosystemic shunt creation can be challenging in newborns and infants. We present a newborn with Trisomy 21, severe portal hypertension secondary to neonatal cirrhosis, oesophageal varices and upper GI bleeding, severe ascites refractory to medical management who underwent ductus venosus stenting as a palliative procedure. He demonstrated remarkable clinical improvement with no subsequent upper GI bleed and resolution of ascites till his last follow‐up at 12 months of age. To the best of our knowledge, stenting of the patent ductus venosus to create a portosystemic shunt to relieve portal hypertension has not been reported in English literature.

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“…In the case of a persistent patent ductus arteriosus (PDA) interventional stent implantation is considered the safer strategy [ 42 , 43 ]. Stenting of the duct has been performed in infants with various complex cardiac lesions with duct-dependent physiology as palliative procedure [ 35 , 43 , 44 , 45 ]. The so-called functional Potts shunt has also been used in various forms of PH, including postcapillary PH [ 43 ].…”

Section: Group 1 Ph ( Table 1 )mentioning

confidence: 99%

Focused Update on Pulmonary Hypertension in Children—Selected Topics of Interest for the Adult Cardiologist

2020

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Pulmonary hypertensive vascular disease (PHVD), and pulmonary hypertension (PH), which is a broader term, are severe conditions associated with high morbidity and mortality at all ages. Treatment guidelines in childhood are widely adopted from adult data and experience, though big differences may exist regarding aetiology, concomitant conditions and presentation. Over the past few years, paediatric aspects have been incorporated into the common guidelines, which currently address both children and adults with pulmonary hypertension (PH). There are multiple facets of PH in the context of cardiac conditions in childhood. Apart from Eisenmenger syndrome (ES), the broad spectrum of congenital heart disease (CHD) comprises PH in failing Fontan physiology, as well as segmental PH. In this review we provide current data and novel aspects on the pathophysiological background and individual management concepts of these conditions. Moreover, we focus on paediatric left heart failure with PH and its challenging issues, including end stage treatment options, such as mechanical support and paediatric transplantation. PH in the context of rare congenital disorders, such as Scimitar Syndrome and sickle cell disease is discussed. Based on current data, we provide an overview on multiple underlying mechanisms of PH involved in these conditions, and different management strategies in children and adulthood. In addition, we summarize the paediatric aspects and the pros and cons of the recently updated definitions of PH. This review provides deeper insights into some challenging conditions of paediatric PH in order to improve current knowledge and care for children and young adults.

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Stenting of the ductus arteriosus for ductal-dependent pulmonary blood flow-current techniques and procedural considerations

Cited by 43 publications

References 25 publications

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

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

Stenting of ductus venosus as a palliation for portal hypertension because of neonatal cirrhosis

Focused Update on Pulmonary Hypertension in Children—Selected Topics of Interest for the Adult Cardiologist

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