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[Application of arterial duct stent in ductus-dependent hypoplastic right heart syndrome]
Insights
Arterial duct (AD) stenting is a safe and effective minimally invasive procedure for children with ductus-dependent hypoplastic right heart syndrome (HRHS). This technique offers a viable alternative to the traditional Blalock Taussig (B-T) shunt, reducing operation and hospitalization times.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Hypoplastic right heart syndrome (HRHS) with ductus-dependent pulmonary circulation presents significant management challenges.
- Traditional palliative shunts like the Blalock Taussig (B-T) shunt carry known risks and longer recovery periods.
Purpose of the Study:
- To evaluate the safety and efficacy of arterial duct (AD) stenting in neonates with ductus-dependent HRHS.
- To compare AD stenting outcomes with those of B-T shunt procedures in a similar patient cohort.
Main Methods:
- A retrospective review of seven children with HRHS who underwent AD stenting between January 2012 and January 2019.
- Comparison of clinical outcomes, including operation time, intensive care unit (ICU) stay, hospitalization duration, and mortality, with nine HRHS patients who received a B-T shunt during the same period.
Main Results:
- AD stenting group showed significantly shorter operation times (108±7 min vs. 160±49 min), ICU stays (3.4±1.0 days vs. 6.3±4.5 days), and total hospitalization (10.3±1.0 days vs. 26.3±1.0 days) compared to the B-T shunt group (all P<0.05).
- Transcutaneous oxygen saturation significantly improved post-AD stenting (0.723±0.125 to 0.926±0.005, P<0.05).
- No complications such as vascular injury, thrombus, or death were observed in the AD stenting group, while the B-T shunt group had a mortality rate of 33% (3/9).
Conclusions:
- Arterial duct stenting is a feasible, effective, safe, and minimally invasive option for ductus-dependent HRHS.
- AD stenting can serve as a valuable alternative to the B-T shunt, potentially improving patient outcomes and resource utilization.
Abstract:
Objective: To summarize the experience of arterial duct (AD) stenting in children with ductus-dependent hypoplastic right heart syndrome (HRHS). Methods: Seven children including 4 cases of pulmonary atresia with intact ventricular septum (PA-IVS) with HRHS and 3 cases of critical pulmonary stenosis (CPS)-IVS with HRHS underwent AD stenting in Qingdao Women and Children's Hospital between January 2012 and January 2019. During the same period, 9 patients of PA-IVS with HRHS received Blalock Taussig (B-T) shunt. Two groups of children on the operation time, hospital stay time, intensive care time and mortality were compared.T test or Mann-Whitney U test was used for comparison between the two groups. Results: There was no significant difference in the age (18 (7-100) vs. 17 (1-142) d, U=31.000, P>0.05) and weight ((3.8±1.1) vs. (3.7±1.3) kg, t=0.272, P>0.05) between the AD stenting group and the B-T group.The operation time ((108±7) vs. (160±49) min, t=-4.304), intensive care time ((3.4±1.0) vs. (6.3±4.5) d, t=-8.692) and total hospitalization time ((10.3±1.0) vs. (26.3±1.0) d, t=-7.822) in the AD stenting group were differed significantly compared with the B-T group (all P<0.05). The transcutaneous oxygen saturation improved significantly (0.723±0.125 vs. 0.926±0.005, t=-6.044, P<0.05) after AD stenting. The diameter of AD stent ranged from 3.5 to 4.0 mm, and the length of AD stent was 16-21 mm. There were no complications such as vascular injury, acute thrombus, catheter spasm and death in the AD stenting group. The mortality of children in the B-T group was 3 in 9 cases. Three cases in the AD stenting group received pulmonary valvulotomy and bilateral Glenn operation at 6, 9 and 9 months after AD stenting, respectively. Conclusions: AD stenting is a feasible, effective, safe and minimally invasive procedure for children with ductus-dependent HRHS. It can even be used as an alternative to B-T shunt.
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