Balloon angioplasty for ductus arteriosus in infant with ductal origin of the left pulmonary artery: combination with nitrogen inhalation therapy.
An infant with truncus arteriosus (Van Praagh A3; isolated left pulmonary artery (LPA) and ductal origin of the LPA) had an extremely stenotic ductus arteriosus (DA) and the LPA could not be demonstrated. As a salvage operation, balloon angioplasty was performed for the stenotic DA at 8 days of age. The minimum lumen diameter of the DA increased from 0.7 to 2.7 mm. After the procedure, the LPA tree was well demonstrated and total pulmonary blood flow increased. Nitrogen inhalation was begun with a nasal positive airway pressure system in order to regulate pulmonary blood flow. Repeat balloon angioplasty was performed at 33 days of age for the restenosed DA. The infant's general condition was stabilized until undergoing pulmonary artery reconstruction and modified Blalock-Taussig shunt at 4 months of age, and definitive repair at 11 months of age. The combination of balloon angioplasty and nitrogen inhalation therapy enabled simultaneous growth of the LPA tree and regulation of total pulmonary blood flow, which could be a useful strategy for complex congenital heart diseases with unbalanced pulmonary blood flow.
Sugiyama
Hisashi
H
Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan. shisashi@yamanashi.ac.jp
Hoshiai
Minako
M
Naito
Atsushi
A
Suzuki
Shoji
S
Nakazawa
Sinpei
S
D000280:Administration, Inhalation; D000800:Angioplasty, Balloon / Q000379:methods*; D004374:Ductus Arteriosus, Patent / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D009584:Nitrogen / Q000008:administration & dosage* / Q000627:therapeutic use; D011651:Pulmonary Artery / Q000254:growth & development; D011652:Pulmonary Circulation; D016896:Treatment Outcome
D009584:Nitrogen