title: Stent implantation in the arterial duct of the newborn with duct-dependent pulmonary circulation: single centre experience from Turkey.
abstract: OBJECTIVE
  Implantation of stents into the ductus arteriosus is an alternative treatment to palliative or corrective cardiac surgery in newborns with duct-dependent pulmonary circulation, although the use of this technique for congenital heart disease is limited.
  
  
  METHODS
  Between April 2010 and June 2011, 13 patients underwent patent ductus arteriosus stenting after full assessment by echocardiogram and angiogram, two of patients had pulmonary atresia (PA) and ventricular septal defect (VSD), six patients had PA with intact ventricular septum (IVS), four patients had critical pulmonary stenosis with IVS and one single ventricle physiology with PA and four patients had radiofrequency-assisted perforation of the pulmonary valve at the same time. All procedures were retrograde through the femoral artery, except one, which was by the femoral vein approach.
  
  
  RESULTS
  The mean age and weight during intervention were 10.5±5.7 days and 3.1±0.4 kg, respectively. The mean of procedure and scopy time, time of stay in intensive care, total out-of-hospital and total follow-up time were 138.88±67.11 min; 40.32±25.86 min; 4.88±6.07 days; 11.00±6.89 days and 86.40±73.21 days, respectively. The mean of the radiation amount was 1054.27±1106.91 cGy/cm2. The mean of saturation before and after intervention were 64.44±5.83; 81.88±6.95%, respectively. Procedure-related deaths were observed in two patients. The causes of death were pulmonary haemorrhage (n=1) and retroperitoneal haemorrhage (n=1). Two patients also died after discharge before surgery due to sepsis (n=1) and aspiration pneumonia (n=1). Eight of 13 patients achieved stent patency during 6 months of follow up and re-stenosis developed in one patient (1/8; 12.5%) who had undergone a Glenn operation at 4.5 months of age.
  
  
  CONCLUSIONS
  Ductal stenting is a practicable, effective, safer and less invasive method compared palliative or corrective surgery. Patients with ductal stenting have growth of the pulmonary artery which provides additional time for surgical repair. Our data suggested that ductal stenting should be considered as a first treatment step in newborns with duct-depended pulmonary circulation. However, long-term palliation without stent re-stenosismight still be a concern especially in patients with hypoplastic pulmonary arteries.
authors.affiliation: Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey. enderodemis@gmail.com
authors.forename: Ender
authors.initials: E
authors.lastname: Odemis
authors.forename: Sertac
authors.initials: S
authors.lastname: Haydin
authors.forename: Alper
authors.initials: A
authors.lastname: Guzeltas
authors.forename: Isa
authors.initials: I
authors.lastname: Ozyilmaz
authors.forename: Meki
authors.initials: M
authors.lastname: Bilici
authors.forename: Ihsan
authors.initials: I
authors.lastname: Bakir
mesh_terms: D000015:Abnormalities, Multiple / Q000401:mortality / Q000601:surgery*; D004374:Ductus Arteriosus, Patent / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery; D006343:Heart Septal Defects / Q000401:mortality / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000379:methods*; D018633:Pulmonary Atresia / Q000401:mortality / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000151:congenital / Q000401:mortality / Q000601:surgery; D015607:Stents; D016896:Treatment Outcome; D014421:Turkey