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Fate of the stented arterial duct

Lookup NU author(s): Dr Christopher Wren, John Hamilton

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Abstract

Background-The technical aspects of ductal stenting have been reported, but little is known of the fate of the duct after stent implantation. Methods and Results-Nineteen patients underwent stent implantation to maintain ductal patency. Eight had hypoplastic left heart (HLH) syndrome, 10 had pulmonary atresia, and 1 had tricuspid atresia. Median survival with HLH was 57 (12 to 907) days. Stent implantation was successful in all cases of HLH, but there were no long-term survivors. Two well-palliated infants died at transplantation. Median survival with duct-dependant pulmonary flow was 183 (0 to 1687) days, with 3 patients well at latest follow-up (56, 55, and 9 months, respectively). There were 2 operative deaths due to ductal spasm and 4 late deaths, 1 due to duct thrombosis, 1 due to chronic lung disease, and 2 of unknown cause. Stent implantation failed in 4 of the 11 cases. Assessment of endothelialization was possible in 13 cases; the stent was partially covered in 3 and fully endothelialized in all 10 cases assessed >8 weeks after implantation. In patients stented for inadequate pulmonary flow, ductal intimal hyperplasia occurred by 9 months in all 3 survivors but responded to repeated dilation. Conclusions-Ductal stenting cannot be recommended. In patients with HLH, it provides only short-term palliation even when combined with pulmonary artery banding. With duct-dependent pulmonary blood flow, the procedure carries high risk, and duration of palliation is poor. In patients with bilateral ducts and absent central pulmonary arteries, good palliation may be achieved, but repeated angioplasty is necessary to counteract intimal hyperplasia.

Publication metadata

Author(s): Gibbs JL, Uzun O, Blackburn ME, Wren C, Hamilton JRL, Watterson KG

Publication type: Article

Publication status: Published

Journal: Circulation

Year: 1999

Volume: 99

Issue: 20

Pages: 2621-2625

Print publication date: 01/05/1999

ISSN (print): 0009-7322

ISSN (electronic): 1524-4539

Publisher: Lippincott Williams & Wilkins

URL: http://dx.doi.org/10.1161/01.CIR.99.20.2621

DOI: 10.1161/01.CIR.99.20.2621

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