Stenting the neonatal arterial duct

Abstract

Ductal stenting in neonates with either duct-dependent pulmonary or systemic circulation has become a good alternative for the initial palliation of complex congenital heart disease. Changes of stent and catheter technology (low profile, flexible, premounted stents with good scaffolding), better patient selection and preparation, optimal interventional access and covering the complete length of the duct have significantly improved results.

Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease

“…224,225 Az elmúlt évtizedben javultak a veleszületett cyanoticus szívbetegségben szenvedő csecsemőkön váloga-tott esetekben végzett ductusstentelés eredményei. [226][227][228][229][230][231][232] Az újabb beszámolókban leírt javuló kimenetel részben a koszorúerek stentelésére tervezett flexibilis, alacsony profilú, 4-5 F méretű hüvelyeken keresztül biztonságosan bejuttatható stentek megjelenésének tudható be. A betegek kiválasztása is javult, miután sikerült azonosítani azokat az újszülötteket, akik számára nagyobb valószínűséggel lesz előnyös a ductus stentelése.…”

Bailout stenting for critical coarctation in premature/critical/complex/early recoarcted neonates

“…The differences in stent design and material determine the cross-sectional area, the strut thickness, and the radial force. Larger metallic crosssectional areas, thicker struts, and smaller cell-areas result in good scaffolding with limited tissue prolapse [17]. These scaffolding properties reduce the flexibility and conformability of the stent which, however, is no issue for this application (nearly straight course from groin to coarctation).…”

Arterial duct stenting: do we still need surgical shunt in congenital heart malformations with duct-dependent pulmonary circulation?

“…Acute or early stent occlusion is seldom reported in large series and also the overall rate of sub-acute stent thrombosis is very low [27]. However, the stented arterial duct tends to be less durable than a conventional surgical shunt due to ductal tissue prolapse through the stent struts and intrastent endothelial hyperplasia, and its midterm fate is spontaneous, slow and progressive closure within a few months [16,18,20].…”