Conventional management of neonates with ductal-dependent pulmonary flow entails maintaining ductal patency using prostaglandin E1 infusion followed by surgical palliation with Blalock-Taussig shunt (B-T shunt). In recent years, percutaneous transcatheter placement of a stent to maintain ductal patency has been used as an alternative method to provide a source of pulmonary blood flow.
A two-day-old boy was referred to our hospital for cardiac evaluation moderate to severe cyanosis (percutaneous oxygen saturation 60%). Echocardiography showed, situs solitus, levocardia, concordant atrioventricular connection, large outlet ventricular septal defect, pulmonary atresia, right aortic arch and vertical arterial duct. Cardiac catheterization was performed via right femoral vein. Pulmonary arteries were hypoplastic and supplied by a vertical, tortuous ductus with distal narrowing which arises from the inner curve of a right sided aortic. Firstly distal narrowed part of ductus arteriosus was stented with a coronary stent (4×15 mm). After that a second coronary stent (4×15 mm) was implanted to cover most of the duct. The final oxygen saturation was 90% after implantation. After cessation of prostaglandin infusion the patient’ oxygen saturation gradually decreased up to the 55%. Second cardiac catheterization showed critically stenosis in aortic end of ductus. A third coronary stent (4×15 mm) was placed to cover the aortic side entirely (Figure 1). The oxygen saturation was increased to 85% after third stent implantation. The patient was discharged with %85 oxygen saturation in the following days. The placement of a duct stent by the percutaneous approach is a good alternative to surgery as a first palliative step in newborns with duct-dependent pulmonary circulation.
