Stent strut dilation in branch pulmonary artery stenosis following stenting of arterial duct in duct dependent pulmonary circulation

Abstract

Abstract Objective To assess the feasibility and outcome of stent strut dilation after arterial duct stenting with associated branch pulmonary artery (BPA) stenosis.Background Stenting of arterial duct in infants with duct dependent pulmonary circulation is technically challenging. Presence of BPA stenosis is a relative contraindication for stent implantation.Methods Infants with duct dependent pulmonary circulation and associated BPA stenosis were assessed either by transthoracic echocardiogram alone or additional computerized tomography (CT) angiogram when required. Following ductal stenting, the stent struts of the stenosed BPA were crossed with an additional 0.014″ coronary guide wire and dilated using coronary balloons (2.0 or 2.5 mm in diameter).Results Seventeen (12 male) patients were considered for the procedure. The median age and weight were 27 days (range 2 to 94) and 2.6 kilograms (range 2.2 to 5) respectively. Fourteen patients (78%) underwent stent strut dilation after arterial duct stenting. Struts to left pulmonary artery was opened in 9 (64%) and right pulmonary artery in 5 (35%). The baseline saturation improved from 66.23 ± 8.9% to 89.29 ± 4.3% after successful strut dilation. Angiographic pulmonary flow improved in all cases. Stent strut dilation could not be done in 3 patients due to unfavorable anatomy. One patient had acute stent thrombosis and died in the hospital. Two others died during follow-up, during an acute febrile illness and gastroenteritis. All survivors underwent cardiac surgery and were on regular follow-up.Conclusions Strut dilation of BPA stenosis is feasible to augment pulmonary blood flow, following arterial duct stenting.