Percutaneous transluminal angioplasty of stenotic ductus arteriosus

This article describes our in vitro experience of balloon angioplasty of the ductus arteriosus (DA) in three post mortem human specimens, as well as an in vivo dilatation of a stenotic DA. The in vitro histologic observations revealed disruption of the intima and areas of pathologically fragmented and disorganized fibers at the media, with integrity of the ductal wall in all three DA. These findings led us to attempt percutaneous transluminal angioplasty (PTA) of a stenotic DA in a 2.3-kg newborn infant with hypoplastic left heart syndrome in a very deteriorated clinical condition. A Rashkind septostomy was associated with PTA of the stenotic DA. Following this, the gradients across the DA and across the atrial septum disappeared and the ductal angiographic diameter increased. Although an improved clinical condition was observed during the following hours, he died 1 day after. At necropsy, we found integrity of the ductal wall with histological changes similar to that observed in vitro. We conclude that PTA of stenotic DA could represent an alternative for palliative treatment of DA-dependent congenital heart disease.