When High-Risk Ductal Stenting Goes Wrong: Use of Percutaneous VV ECMO Support and Acute Left Pulmonary Artery Loss

Patent ductus arteriosus (PDA) stenting is a vital intervention for neonates with ductal-dependent blood flow, offering an attractive alternative to surgical shunt placement. Despite its benefits, the procedure poses risks such as ductal spasm, branch pulmonary artery compromise, and pseudoaneurysm formation. This report presents two complex neonatal cases with distinct outcomes. The first patient experienced severe ductal spasm, pseudoaneurysm formation, and ductal dissection. Innovative use of percutaneous venovenous extracorporeal membrane oxygenation (VV ECMO) provided hemodynamic stability, enabling staged interventions and eventual successful ductal stenting. The second patient experienced acute left pulmonary artery flow loss due to ductal spasm. Transcatheter attempts to restore flow failed, necessitating surgical stent removal and Blalock-Taussig-Thomas shunt placement. These cases highlight the challenges of PDA stenting in complex ductal anatomies and the importance of advanced imaging, careful wire and catheter selection, and multidisciplinary collaboration. Notably, the first reported use of percutaneous VV ECMO during PDA stenting demonstrates its potential as a lifesaving adjunct for these cases.