PDA Stenting in Duct-Dependent Pulmonary Circulation

Abstract

Surgical aortopulmonary shunts that palliate neonates with duct-dependent pulmonary circulation are associated with a mortality ranging from 8% to 12%. The surgical morbidity includes prolonged ventilation and intensive care stays, bleeding and transfusions, prolonged inotropes, pulmonary complications, sepsis and injury to phrenic nerve, recurrent laryngeal nerve, and thoracic duct. Ductal stenting (DS) is increasingly replacing surgical shunts as a nonsurgical alternative. The key bottleneck on follow-up is a progressive fall in oxygenation due to intimal ingrowth within the ductal stents and fibrointimal peel formation and thrombus within surgical shunts. About 5–20% of patients suddenly die on follow-up due to shunt or stent thrombosis. The advances in neonatal ductal stenting in the recent years include use of drug-eluting stents which may delay intimal ingrowth, pre-procedural image-guided selection of vascular access that includes percutaneous axillary artery or surgical carotid cut down, technical modifications like use of microcatheters to manipulate very tortuous ducts, and special strategies in confluence stenosis. This review describes the different indications and contraindications, procedural details, complications, and post-procedural follow-up after DS.