PDA Stenting: Past, Present and Future

The modified Blalock Taussig shunt (mBTS) has been the mainstay of palliation of lesions with ductal dependent pulmonary blood flow (DD-PBF). However, even in the current era this has been associated with post-operative instability and 30-day mortality in excess of other more technically complex neonatal operations. This has been partly attributed to a case-mix that include more complex lesions or severely ill neonates, leading to a drive toward alternative approaches in the palliation of these neonates.

In the last decade, ductal stenting (DS) has gained wider acceptance as alternative to mBTS. In recent publications, multicenter collaborative efforts that compared the outcomes of BTS with DS – though retrospective in nature – have validated some of the merits of DS observed in preceding single-center case series.

With our shared accumulated experience, we are seeing some degree of standardization of the PDA stenting procedure e.g. the role of pre-procedure advanced imaging, choice of vascular access, techniques and materials, post procedure management and inter-stage follow-up. It is still too early, however, to say that we are at the cusp of a new era where DS will soon supplant mBT as the palliation procedure of choice. There are procedural complications that are unique to DS, and durability of palliation is a concern although earlier definitive surgical repair has become the norm for the majority of complex cyanotic CHD. Publications on surgical experience at repairing lesions that had been palliated with DS is still a trickle. And fundamentally, DS remains a procedure that relies of materials borrowed from the coronary interventional world. There are certain aspects of complex PDA morphology in neonates with DD-PBF that may be better served by stents that are specifically designed for this purpose.

In this context, Pediatric Cardiology and PICS have embarked on opening a PICS Collection named “PDA stenting: past, present and future”. We are pleased to announce that Dr. Alwi and Dr. El Said are the invited guest editors for this special PICS Collection. We invite experts and researchers in the field to submit original research and review papers on the topic of PDA stenting, specifically focusing on areas such as advanced imaging, procedural techniques, post-procedure care and follow-up, and surgery post DS, long term results, new stent development and work related to this subject. We particularly encourage original research papers that present new scientific findings and outcomes, as well as review papers that provide a comprehensive overview of the current state-of-art and future directions on this topic. For review papers, we encourage authors to critically evaluate and synthesize existing research, identify key gaps in knowledge or limitations in current practices, and propose innovative ideas or new directions for future research on this topic.