Abstract
Objective
Ductal stenting (DS) has emerged as a critical intervention for neonates with duct-dependent pulmonary circulation (DDPC), offering a less invasive alternative to surgical shunts.
Methods
This retrospective study evaluates the procedural and mid-term outcomes of neonatal DS at a high-volume tertiary cardiac centre between January 2018 and August 2023.
Results
The study involved 124 symptomatic neonates. Primary outcomes included procedural success, defined as achieving post-procedural oxygen saturation (SpO2) ≥85 %, and survival to planned surgical repair. Secondary outcomes assessed included unplanned re-interventions, pulmonary artery growth, and all-cause mortality within 6 months. Success rate was 98.5 %. Total hospital stay was 3.17 ± 4 days. All-cause mortality was 8.9 %. Branch PA origin stenosis was found in 42 % cases on follow up.
Conclusion
The study concludes that DS is a feasible and effective strategy in a variety of different cases of DDPC. Further research is needed to explore long-term outcomes and optimal stent selection based on individual patient characteristics.
Keywords: Ductal stenting, Neonatal interventions, Duct dependent pulmonary circulation
1. Introduction
Duct-dependent pulmonary circulation (DDPC) is a spectrum of congenital heart diseases that manifest in early infancy following closure of ductus arteriosus and necessitates early intervention to augment pulmonary blood flow. Establishment of adequate pulmonary blood flow (PBF) in early life is essential for survival in children with DDPC. The management strategies for symptomatic neonates with DDPC involve prompt use of prostaglandin‐E1 infusion and subsequent palliation with surgical modified Blalock Taussig Thomas (m-BTT) shunt or percutaneous ductal stenting (DS) followed by staged repair.
Palliative stenting of the ductus arteriosus was introduced as a novel concept to possibly substitute surgical modified Blalock Taussig Thomas shunt with earliest published data in 1992 by Gibbs et al. Over past two decades, palliative neonatal ductus arteriosus (DA) stenting for DDPC has become a reliable and acceptable alternative to m-BTT shunt for infants with DDPC particularly on account of innovations in hardware, refinement in stents/stenting techniques and evolving experience of operators1, 2.
The study was designed to assess overall safety and efficacy of DA stenting in neonates with DDPC. Neonatal DA stenting was intended to provide initial palliation and thus avoid (or delay) surgical shunt in view of the higher postoperative morbidity, mortality, and significant post-surgical shunt re-interventions associated with surgery.
2. Methods
2.1. Study design and study population
It was a retrospective descriptive study consisting of consecutive symptomatic neonates with DDPC who underwent DA stenting for initial palliation from January 2018 to August 2023 by a single primary operator at a high volume tertiary cardiac facility in Western India. The aim was to evaluate procedural outcomes, complications, and follow-up results as part of institutional experience. Each patient underwent DA stenting in the cardiac catheterization laboratory using a standard protocol after informed consent. The choice of the particular stent [DES (Drug-Eluting Stent) or BMS (Bare Metal Stent)] used was dependent on availability of stents at the time of cardiac catheterization. Bare metal stent was initially preferred over DES in view of limited data on efficacy of DES in DA stenting, but in later part of study, it was changed to DES due to non-availability of bare metal stent at our centre.
The medical records were reviewed to ascertain clinical profile, procedural characteristics, in-hospital and short-term and mid-term outcomes. The clinical profile particularly history of preterm birth, birth weight, anthropometry, oxygen saturation (SpO2) at admission, cardiac anatomy and age at the time of intervention were recorded. Comprehensive echocardiography was pivotal to establish bedside diagnosis with special focus on ductal anatomy and branch pulmonary arteries (PA) using 6–12 MHz frequency transducers. The anatomy of DA and branch pulmonary arteries were defined in parasternal short axis, suprasternal short axis and suprasternal long axis views using two dimensional and Doppler imaging. The pre-procedural planning for access route selection was primarily based on duct morphology assessed from echocardiography. Multi-detector computed tomography (MDCT) was done in selected cases whenever there was concern for ductal and branch PAs anatomy even after detailed echocardiography. MDCT was done in a very small number of cases pre procedurally, mainly relying on detailed echocardiography. As an institutional policy, PDA stenting was done in all cases, even in those with pre-existing branch PA stenosis, with plan to PA plasty as needed during subsequent palliative/complete repair. Neonates with SpO2 ≤85 % were started on PGE1 infusion at admission and continued till a night prior to procedure (PGE1 was stopped on the morning of the procedure (5–6 h prior) to allow duct to constrict sufficiently to hold stent). However, in a small number of patients who fail to tolerate even a few hours without PGE1 infusion, it was restarted with frequent titrations to maintain SpO2 ≥70 % at lowest possible dose and subsequently turned off just before or at the beginning of the procedure. Routine biochemical, haematological and serologic investigations including septic screening were obtained expeditiously for all subjects.
Inclusion criteria-
-
•
Symptomatic neonates with DDPC and arterial oxygen saturation (SpO2) ≤ 85 % treated primarily with DA stenting
Exclusion criteria-
-
1)
DA morphology not suitable for stenting particularly extremely tortuous PDA. Extremely tortuous duct was defined as having more than 3 acute turns.
-
2)
Non-confluent branch Pas
-
3)
DA stenting done for non DDPC physiology
2.2. Procedure
All neonates received loading with aspirin (ASA) 10 mg/kg on the previous night before procedure. As a protocol, the procedures were primarily done under monitored intravenous anaesthesia without invasive ventilation while general anaesthesia with invasive ventilation was used in few select cases by expert paediatric anaesthetists with a special attention to minimize hypothermia and apnoea. Procedural characteristics such as central aortic pressure, ductal anatomy and hardware (such as guide catheters, guide wires, stents), procedural time, fluoroscopic time, amount of contrast medium and post procedural SpO2 were noted. The neonatal ductal stenting was done commonly via trans arterial approach (retrograde approach) or trans venous approach (ante grade approach). The axillary approach was preferred for vertical duct (Fig. 1a) while femoral approach for horizontal ducts and DA from innominate artery (Fig. 1b and c). Intravenous heparin 100 units/kg was given at the start of the procedure and repeated as per activated clotting time (ACT) every 1 h. The baseline central aortic pressure was recorded, and the duct was selectively engaged using appropriate pre-shaped guide catheters such as Judkins right (JR), internal mammary artery (IMA). Ductal angiograms were performed to delineate ductal anatomy (including its origin, shape, size, course, tortuosity, length, diameter near the pulmonary end) and any stenosis in branch PAs using hand injections done preferably in lateral and left anterior oblique (LAO) views. Every precaution was taken to restrict total use of Iodixanol (Visipaque, GE Healthcare), an iso-osmolar contrast medium to less than 4 ml/kg. To achieve this, a 1:2 dilution of contrast medium was used in every case. The duct was usually negotiated with a 0.014″ floppy-tipped workhorse guide wire (GW) commonly Balance Middle Weight (BMW). In select cases, Whisper MS or Choice PT extra support guide wires were used to negotiate tortuous PDA (single wire technique) or support tracking of the stent with or without workhorse GW (dual wire technique) with the distal tips of GW parked in distal branches of either one or both pulmonary arteries.
Fig. 1.
(a) Diagram showing vertical ductus arteriosus. Axillary artery approach preferred for this anatomy. (b) Diagram showing horizontal ductus arteriosus. Femoral artery approach preferred for this anatomy. (c) Diagram showing ductus arteriosus from the base of the innominate artery. Femoral artery approach preferred for this anatomy.
The choice of the particular stent (DES or BMS) used was dependent on availability of stents at the time of cardiac catheterization. All the BMS implanted were Abbott Vascular Multi-Link stents (Abbott Vascular, Santa Clara, California). All the DES implanted were of second-generation everolimus eluting stents; either Boston Scientific Promus Premier stents (Boston Scientific, Natick, Massachusetts) or Abbott XIENCE stents (Abbott Vascular, Santa Clara, California). The pre-mounted coronary stents were deployed in all the cases after confirmation of coverage of both ends of duct in appropriate angiographic projections. The selection of nominal stent diameter was based on the ductal anatomy and weight of patient. Generally, a 4 mm diameter stent was selected for infants weighing >3 kg, a 3.5 mm diameter for those weighing 2.0–3.0 kg, and a 3 mm diameter for those <2 kg. The length of stent was chosen to cover the entire length of the duct with proximal end into aorta and distal end into branch PA. After stent deployment, contrast injections were done with guide catheter to confirm position of stent and its coverage of both ends of duct and flow into branch pulmonary arteries (PA). The procedural success was defined as successful stent deployment with brisk flow into the PA branches without the need for emergent surgical shunt and post-procedural SpO2≥85 %. After procedure, all patients were intensively monitored along with SpO2 in NICU and received intravenous heparin infusion for 24 h (target APTT ratio of 1.5–2.5). The dual antiplatelet agents including aspirin (5 mg/kg/day) and clopidogrel (0.5–1 mg/kg/day) were initiated post-procedure and continued until definitive surgery. The transthoracic echocardiography was done peri-procedure and after 24 h to assess branch PA, ductal stent position and its patency. Also, records were examined to ascertain any local site adverse event, need for peri-procedural (≤24 h) blood transfusion, inotrope infusion or invasive ventilation.
2.3. Discharge and follow-up
The neonates were discharged on antiplatelets. They were followed up initially after 15 days and then on monthly basis with particular focus on echocardiographic assessment for stent patency and adequacy in growth of PA branches and oxygen saturation. The follow-up period for all outcomes included the time to complete anatomic repair (for patients with complete 2-ventricle repair), to palliative superior Cavo pulmonary connection (for patients with single ventricle repair) or to the last follow-up (for patients who have not undergone surgical repair). The details of any unplanned interventions/surgical aortopulmonary shunts and staged surgeries were noted. The multi-detector computed tomography (MDCT) was performed in all patients planned for surgical repair.
2.4. Outcomes
The primary outcomes were procedural success in terms of SpO2> 85 % post stenting and survival to next planned surgical repair i.e. complete anatomic repair (for patients with complete 2-ventricle repair), to palliative superior Cavo pulmonary connection (for patients with single ventricle repair). The secondary outcomes were unplanned interventions to treat cyanosis and PA size growth (evaluated by z-scores). An unplanned re-intervention was defined as an intervention performed specifically for a decrease in systemic oxygen saturation as clinically indicated by the treating physician. The records were examined to assess duration of post–index procedure hospital stay, need for post-procedural inotropic support (>24hr), need for post-procedural ventilation (>24hr), access related adverse event, infection and diuretic usage at hospital discharge.
2.5. Statistical analysis
Statistical analyses were performed using the SPSS 26.0, Chicago, USA. Continuous variables were expressed as mean ± SD, and Categorical variables are represented by frequencies or percentages.
3. Results
A total of 124 neonates of duct-dependent pulmonary circulation with mean age of 5.93 ± 5.20 (1–12 days) and weight of 2.67 ± 0.44 kg (1.8–3.9 kg) underwent ductal stenting with procedural success of 98.5 %. 6 patients had to be excluded because of extremely tortuous ductus.
There were 17 % pre-terms <37 weeks of age. The mean arterial oxygen saturation at admission (baseline) was 72 % and pre-procedural prostaglandin infusion was required in 88 % of neonates. 3 neonates required restarting of PGE1 infusion, 1 during the procedure, and 2 before the procedure.
The anatomic diagnosis and pre-procedural planning was based on bedside comprehensive echocardiography, however additional imaging with MDCT was done in 20 %. Of the total 124 subjects, 85 % neonates had situs solitus and 65 % had expected 2 ventricle physiology. The mean right PA (RPA) and left PA (LPA) Z-scores were −1.37 ± 0.6 and −1.06 ± 0.6 respectively. The DA was tortuous in 25.2 % subjects and aberrant ductal origin from either subclavian or innominate arteries was noted in 11.2 % cases. The baseline characteristics of the cohort are summarised in Table 1. The mean age at the index procedure of ductal stenting was 14.43 ± 7.13 days. In addition to ductal stenting, 10.81 % subjects underwent successful balloon pulmonary valvuloplasty (BPV) for isolated critical pulmonary stenosis while 6.76 % subjects underwent successful right ventricular outflow tract (RVOT) perforation for membranous pulmonary atresia with intact ventricular septum. 12.1 % patients required peri-procedural ventilator care while 87.84 % patients underwent ductal stenting under monitored anaesthesia only. Peri-procedural inotrope support was needed in 14.8 % while peri-procedural blood transfusion was mandated in 4.05 %. The neonatal DA stenting was done by trans-arterial approach (retrograde) in 96 %. The femoral arterial access was used in 50 % (for horizontal duct) while axillary arterial access was used in 45 % (preferred for vertical duct). The transvenous approach (ante grade approach) was utilised in 4 % (Table-2).
Table:1.
Patient demographics and baseline characteristics.
| Variable | Total (n = 124) |
|---|---|
| Age at admission (days) | 5.93 ± 5.2 |
| Age at Intervention (days) | 14.43 ± 7.13 |
| Weight (kg) | 2.67 ± 0.44 |
| Height(cm) | 48.04 ± 3.92 |
| Prematurity (<37 weeks) (%) | 21(17 %) |
| Pre procedure SpO2 (%) | 71.9 ± 6.1 |
| Expected Two ventricle physiology | 81(65 %) |
| Prostaglandin Use (%) | 111(87.8 %) |
| Ductal morphology | |
|
28(22.5 %) |
|
51(41 %) |
|
14(11.2 %) |
|
31(25.2 %) |
| Branch PA size | |
| RPA Z scores | −1.37 ± 0.6 |
| LPA Z scores | −1.06 ± 0.6 |
PA-Pulmonary artery, RPA-Right pulmonary artery, LPA- Left pulmonary artery, ∗P-value <0.05 shows statistically significant.
Table: 2.
Procedural details.
| Variable | Total (n = 124) |
|---|---|
| Access | |
|
56(45.2 %) |
|
62(50 %) |
|
6(4 %) |
| Without mechanical ventilation | 109(87.9 %) |
| With Mechanical ventilation | 15(12 %) |
| Fluoroscopy Time (min) | 12.3 ± 0.3 |
| Radiation Dose (mGy) | 20.3 ± 14.3 |
| Dye Volume (ml/kg) | 4.85 ± 0.7 |
| Post-procedure SpO2 (%) | 88 ± 0.6 |
∗P-value <0.05 shows statistically significant.
The duct was crossed with one of the guide wires BMW, WMS or CPT-ES. The single guide wire technique 72(58 %) was used for non-tortuous ducts with distal tip of guide wire parked in RPA or LPA. In cases with difficult to deliver stent across duct and/or complex ductal morphology, dual guide wire technique 52(42 %) was preferred with distal tips of guide wires parked in RPA (Right pulmonary artery) LPA (Left pulmonary artery) or RPA and LPA both. A total of 124 stents (82 BMS and 42 DES) were deployed with mean diameter of 3.64 ± 0.34 mm and mean length of 16.55 ± 3.93 mm was deployed in 124 neonates. The mean fluoroscopy time was 12.3 min. The mean radiation dose was 20.34 ± 14.33 mGy. The mean arterial oxygen saturation increased significantly from baseline-value to 88 ± 0.6 after ductal stenting. The procedural characteristics were comparable between the 2 groups.
The total post-procedural hospital stay was 3.17 ± 0.4 days. The all cause in-hospital mortality of 8.9 % (n = 11) (Table-3). 3 of them died due to post procedure severe pulmonary oedema & pulmonary haemorrhage, 3 due to severe desaturation in case of extremely tortuous ducts who developed bradycardia & hypotension while placement of the stent and uncovered pulmonary arterial end of the ductus in Cath lab, 1 of them developed DA dissection with subsequent severe cyanosis while 4 of them succumbed to severe sepsis. The median duration of follow up was 218.62 days for patients after excluding subjects with primary endpoints within 1 month. In-hospital morality was n = 11 and in hospital Aorto pulmonary shunt was n = 6. The mean RPA and LPA Z-scores were 0.61 ± 0.93 and 0.3 ± 0.49 respectively while the mean SpO2 (%) was 82.9 ± 10. The distorted branch pulmonary artery morphology was seen in 42 % subjects (Table-4). The mid-term all-cause mortality was 2.7 % (n = 3) of which 1 infant died at remote hospitals after a brief period of worsened cyanosis with probable subacute stent thrombosis and other patient succumbed to severe sepsis. The subject with subacute stent thrombosis had preceding diarrhoea and hypovolemic shock at presentation to remote hospital. The surgical aorto-pulmonary shunt was performed for acute worsening cyanosis between 1 and 6 months of peri-index procedure in 7.2 % subjects (n = 9) for definite stent thrombosis with history of non-compliance to antiplatelets in one of these subjects. The primary outcome i.e. survival to staged surgery was seen in 84.1 % (n = 90). 5 children, who underwent RVOT perforation along with ductal stenting, are still under follow up. 2 Out of these 5, RV has grown well, and they are maintaining good saturation. The other 3 children are planned to undergo one and half ventricle repair. The early and mid-term outcome variables were comparable between the 2 groups (Table-3, Table-4).
Table: 3.
Post-procedural outcomes.
| Variable | Total (n = 124) |
|---|---|
| Post procedure Hospital Stay (days) | 3.17 ± 0.4 |
| Adverse events | 12(9.6 %) |
|
3(25 %) |
|
5(41.7 %) |
|
1(8.3 %) |
|
3(25 %) |
| In-hospital Mortality (%) | 11(8.9 %) |
| Aorto-pulmonary shunt, n (%) | 6(4.8 %) |
LV-Left ventricular, ∗P-value <0.05 shows statistically significant.
Table: 4.
Follow-up and long-term outcomes.
| Variable | Total (n = 107) |
|---|---|
| Follow-Up Duration (days) | 242.62 ± 126.9 |
| SpO2 at Follow-Up (%) | 82.9 ± 10 |
| Pulmonary Artery Distortion (%) | 45(42 %) |
| All-Cause Mortality (1–6 months) (%) | 3(2.8 %) |
| Aorto pulmonary shunts (1–6 months) n (%) | 9(7.2 %) |
| Staged surgeries(n) (%) | 90(84.1 %) |
| Branch PA size | |
| RPA Z scores | 0.61 ± 0.93 |
| LPA Z scores | 0.3 ± 0.49 |
PA-Pulmonary artery, RPA-Right pulmonary artery, LPA- Left pulmonary artery, ∗P-value <0.05 shows statistically significant.
4. Discussion
This single centre, retrospective study demonstrates that PDA stenting is a safe and effective initial palliation in neonates with duct-dependent pulmonary circulation (DDPC). It focuses on procedural success, complications, and medium-term outcomes.
The procedural success rate of 98.5 % in this cohort aligns with existing literature, affirming DA stenting as a reliable intervention for neonates with DDPC. The selection of access routes—axillary in 45 % and femoral in 50 %—demonstrates the procedure's adaptability to individual anatomical variations. This flexibility is crucial in optimizing outcomes and minimizing access-related complications.
DS is a technique sensitive procedure, and multiple technical factors affect procedural outcomes. We preferred femoral arterial access for straight ducts and also for ducts from SCA or innominate artery, and we used axillary access for vertical ducts from under surface of arch. We did not use carotid access. Buys et al reported 80–100 % procedural success while avoiding stenting tortuous and vertical ducts.,14 we were able to stent all ductuses including tortuous ducts present in 25 % of cases. While on the other hand, bahaidarah reported success rate of 93 % in a cohort comprising of almost 80 % cases with tortuous ducts.15 But they did not use axillary (or carotid) access. 17 % of our cohort was either preterm or had weight <2 kg, suggesting feasibility of DS in this group. It can be surmised that skill development with mounting experience plays a greater role in successful DS. Our procedural fluoroscopy duration was notably lower as compared to others.8
The in-hospital mortality rate of 8.9 % observed in this study is comparable to or lower than rates reported in other series, suggesting that DA stenting carries an acceptable risk profile. Causes of mortality included pulmonary oedema, stent thrombosis, and sepsis. Notably, the incidence of peri-procedural complications was 11 %, which is consistent with other reports indicating that procedural complications are relatively infrequent.
Our acute complications rate was nearly 11 %, which included 5 cases of pulmonary oedema and 3 cases of acute limb ischemia which we believe are preventable. Appropriate stent sizing and use of ultrasound probe for vascular access can minimize these complications. Technical difficulties owing to tortuous ducts requiring escalated dye volumes in neonates has been a hindrance in a number of cases.
Our primary outcome of survival to staged surgery occurred in ∼72 % of cases. Our 8.9 % mortality rate was comparable to other studies. Glatz et al in their multicentre retrospective cohort study reported 6 % mortality while Ratnayake et al reported 6.4 % mortality in their single centre retrospective cohort study.4,5 While Santoro et al had a lower mortality rate of 3.6 % over a 10 years’ experience,6 others like amoozgar et al and bentham et al had 20 % and 18 % mortality each.7,8 Overall, there is a trend of decreasing mortality with increasing experience. Our technical success rate of a successful DS procedure completion was 98.6 %. Not just straight ducts, we were able to put stent in tortuous ductal anatomy too. In fact, gradually since this study, we have moved to the universal ductal stenting approach, weaning away from riskier aortopulmonary shunts. Our results can be attributed to an evolved learning curve & continuous refinement of techniques.
Inter stage mortality of DS has been found to be significantly less than aorto pulmonary shunts.8,12 Our inter stage mortality of 3 cases & 9 cases requiring aortopulmonary shunts during 1–6 months were probably secondary to in stent thrombosis. Re-interventions were required in 11 % in those with DES & 14.2 % in those with BMS.
A significant finding is the improvement in branch pulmonary artery (PA) Z-scores during follow-up, indicating favourable pulmonary artery growth post-stenting. This outcome is essential for patients awaiting further surgical interventions. However, a reintervention rate of 12 % was noted. While some studies report higher reintervention rates, the lower rate in this cohort may reflect effective patient selection and procedural techniques. Nonetheless, the need for reintervention underscores the importance of meticulous follow-up and timely management of complications.
Several studies have demonstrated that ductal stent effectively promotes pulmonary arterial growth. We observed uniform increase in bilateral branch PA Z scores on follow up echocardiographic studies. Branch PA stenosis remains a notable complication, consistent with previous reports and warrants close follow up. Distorted branch pulmonary artery morphology was seen in 42 % of cases on follow up. This was similar to recent data published by Sasikumar et al who found branch PA distortion and subsequent need for PA reconstruction in 39.8 % cases.13 Ductal stent is commonly positioned such that 1–2 mm of the stent extends into the pulmonary artery and also beyond the ductal ampulla into the aorta, this gives a margin of safety especially in cases of long tortuous ducts and besides that, its technically very difficult not to protrude any length of stent in branch PA whatsoever. Alwi et al reported that the existence of a ductal stent increases pre-existing stenosis of the PAs due to metal grid of the stent causing neointimal proliferation and fibrosis in the ductal tissue surrounding the Pas.16 Sivakumar et al did not find difference between DES & BMS in effect on PA growth.17
Additionally, study done by Cheng et al on impact of DS on DA length & pulsatile flow provided evidence that the choice of stent can influence the hemodynamics within pulmonary arteries, potentially affecting PA growth & long-term outcomes.18 Haranal et al showed that though DS can increase branch PA stenosis, especially when protruding into any branch PA, DA stent removal or transection during subsequent surgery was always feasible, without complications and independently of the time interval between implantation and surgery.19 Furthermore, they stated that lack of surgical scars deriving from previous surgeries reduced the technical difficulty of the subsequent surgery.
Re-intervention rates have previously been described as higher with DA stenting when compared to aortopulmonary shunts, with re-intervention rates ranging from 23 to 47 %.9,10 We required re-intervention in 15(12 %) cases, majority of re-intervention was nonurgent, and there were no deaths during the re-intervention procedure. Stent dilation or additional stents were not required in any of the cases. It has been suggested earlier that DES are a risk factor for higher re-intervention rates.11 But our re-intervention rates were similar irrespective of stent type.
DA stenting offers several advantages over traditional surgical aortopulmonary shunts, including reduced procedural complications and shorter hospital stays. Additionally, stenting avoids thoracotomy and its associated morbidities, making it a less invasive option for neonates.
On subgroup analysis between DES & BMS, we found no significant difference in terms of outcomes. DES has a proven role in adult coronary artery diseases. DES have been said to reduce intimal ingrowth and proliferation.20 But studies on role of DES vs. BMS in DS are very few. Aggarwal et al compared 46 BMS and 25 DES patients and found that DES resulted in less luminal loss and lead to lower re-interventions as compared to BMS.3 Siva kumar et al found ductal patency to be lasting longer with DES than BMS.17 We found survival to staged surgery slightly shorter in DES group, though this was not statistically significant.
4.1. Study limitations
This study is limited by its retrospective design and single-centre setting, which may introduce selection bias and limit the generalizability of the findings. Future prospective, multicentre studies with extended follow-up are warranted to validate these results and provide more comprehensive data on the durability and long-term efficacy of DA stenting in this population.
5. Conclusion
DA stenting in neonates with duct-dependent pulmonary circulation is a feasible and effective intervention demonstrating high procedural success, acceptable complication rates, and favourable pulmonary artery growth. Careful patient selection, individualized procedural planning, and diligent follow-up are essential to optimize outcomes and minimize the need for re-interventions.
Ethical approval
Ethical approval was waived by the Institutional Ethics Committee (UNMICRC/CARDIO/2023/26) in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.
Consent
This retrospective study involves analysing data that were previously collected as part of routine care. We have waiver consent for this study.
Funding
No funding was received for conducting this study.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgement
I thank Dr Shyam Sunder Kothari for guiding in the preparation of manuscript. And all of co-authors for supporting in the preparation of the manuscript.
Contributor Information
Bhavik Champaneri, Email: champaneribhavik7@unmicrc.org.
Abhay Pota, Email: potaabhay07@gmail.com.
Tarun Parmar, Email: drtarunp@unmicrc.org.
Jigar Surti, Email: drjigarsurti@gmail.com.
Shilpa Deodhar, Email: drshilpadeodhar@yahoo.co.in.
Amit Kungwani, Email: amitkungwani@yahoo.com.
Suresh Bishnoi, Email: bishnoisureshsimple@gmail.com.
Amit Mishra, Email: drmishraamit@gmail.com.
Trushar Gajjar, Email: trushargajjar@gmail.com.
Shyam S. Kothari, Email: kothariss100@gmail.com.
Abbreviations:
- DS
Ductal stenting
- DDPC
Duct-dependent pulmonary circulation
- DA
Ductus arteriosus
- DES
Drug-Eluting Stent
- BMS
Bare Metal Stent
- PA
Pulmonary Arteries
- MDCT
Multi-detector computed tomography
- BMW
Balance Middle Weight
- BPV
Balloon pulmonary valvuloplasty
- LPA
Left pulmonary artery
- RPA
Right pulmonary artery
- PGE1
Prostaglandin E1
- ACT
Activated clotting time
- JR
Judkins right
- IMA
Internal mammary artery
- LAO
left anterior oblique
- DS
Ductal stenting
- PBF
Pulmonary blood flow
- m-BTT
Modified Blalock Taussig Thomas
- RVOT
Right ventricular outflow tract
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