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Fate of Duct-Dependent, Discontinuous Pulmonary Arteries After Arterial Duct Stenting
Giuseppe Santoro1,2, Giovanbattista Capozzi3, Mario Giordano3
1Paediatric Cardiology and GUCH Unit, Ospedale del Cuore "G. Pasquinucci", Massa, Italy. santoropino@tin.it.
Insights
Trans-catheter arterial duct stenting effectively promotes pulmonary artery growth in patients with duct-dependent discontinuous pulmonary arteries. This minimally invasive approach offers a viable alternative to surgical palliation for congenital heart disease.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Arterial duct (AD) stenting is known to promote pulmonary artery (PA) growth.
- Data on AD stenting for duct-dependent discontinuous pulmonary arteries (dPA) are lacking.
- Congenital heart disease with dPA requires effective palliative strategies.
Purpose of the Study:
- To evaluate the efficacy of trans-catheter AD stenting in promoting growth of dPA.
- To assess the role of AD stenting as a palliative approach for dPA.
- To compare the growth of dPA with heart-dependent PAs (hPA) post-stenting.
Main Methods:
- Seven patients with dPA underwent neonatal AD stenting.
- PA growth was assessed using Nakata index and McGoon ratio.
- Measurements included dPA and hPA size and z-score changes pre- and post-stenting.
Main Results:
- AD stenting significantly increased oxygen saturation (83% to 95%).
- Significant catch-up growth of dPA was observed post-stenting (p < 0.001).
- A trend towards better dPA growth compared to hPA was noted, though final sizes differed.
Conclusions:
- Percutaneous AD stenting is effective in promoting significant growth of dPA.
- This technique serves as a reliable alternative to surgical palliation for dPA.
- AD stenting is advisable for managing congenital heart disease with dPA.
Abstract:
Significant and balanced PA growth following arterial duct (AD) stenting has already been consistently reported in literature. However, to date, no data are available about the role of this approach as palliation of congenital heart disease with a duct-dependent discontinuous pulmonary artery (dPA). The aim of this study was to evaluate the fate of a dPA of ductal origin following trans-catheter AD stabilization. Angiographic PA evaluation was performed in seven patients submitted to neonatal AD stenting as palliative recruitment of dPA. Five patients showed discontinuity of one PA, while two patients had both PAs served by bilateral ducts. PA growth was evaluated as per the Nakata index, McGoon ratio as well as dPA (n = 9) versus heart-dependent PA (hPA; n = 5) size and z-score changes. AD stabilization was performed using coronary stents dilated to 3.2 ± 0.3 mm (median 3.4), with significant increase of O2 saturation (from 83 ± 11 to 95 ± 5%, p < 0.02). Control angiography was performed 5.1 ± 2.8 months (median 6 months) after duct stenting, showing significant growth of the dPA (from 3.7 ± 1.0 to 7.6 ± 2.7 mm, p < 0.001; z-score from -0.7 ± 1.4 to 1.7 ± 2.2, p < 0.01). A trend toward better growth of the dPA as compared with the hPA was found (117 ± 87 vs. 54 ± 34%, p = NS). The final vessel size was still significantly different between the groups (dPA 7.6 ± 2.7 vs. hPA 11.9 ± 3.4 mm, p = 0.02), although the final z-score value did not significantly differ (dPA 1.7 ± 2.2 vs. hPA 3.8 ± 0.9 mm, p = NS). In conclusion, percutaneous AD stenting is effective in promoting a significant catch-up growth of duct-dependent dPA, being, therefore, advisable as a reliable alternative to surgical palliation.
