title: Stenting the arterial duct in neonates and infants with congenital heart disease and duct-dependent pulmonary blood flow: a multicenter experience of an evolving therapy over 18 years.
abstract: OBJECTIVE
  The primary aim of this multi-institutional study was to describe our 18-year experience of ductal stenting (DS) in infants with a duct-dependent pulmonary circulation. The secondary aim sought to identify a subgroup of patients who may benefit the most using this evolving technique.
  
  
  BACKGROUND
  No study has examined the extraordinary evolution of this promising therapy over the last two decades.
  
  
  METHODS
  Between 1991 and 2009, 65 neonates and infants (39 male, 60%) underwent cardiac catheterization for DS in 3 participating centres. Patients were divided according to whether DS was attempted between 1991-2000 (Group 1, n = 20) or between 2001-2009 (Group 2, n = 45).
  
  
  RESULTS
  DS was successful in 52/65 (80%) patients. DS outcome was associated with ductal morphology and cardiac diagnosis. DS failed more often in patients with univentricular physiology and tortuous duct morphology (p < 0.001). Most patients undergoing DS in Group 2 had pulmonary atresia with intact ventricular septum (PAIVS) (p < 0.001). DS was successful in 94% of these patients. Groups differed significantly in diameter and length of first implanted stent (p < 0.001), implanting additional stent (p < 0.001), and occurrence of complications (p = 0.033). Freedom from re-intervention for the 52 patients was 92.3%. No procedure-related mortality occurred.
  
  
  CONCLUSIONS
  The technical aspects and clinical application of percutaneous DS has changed in the last two decades. DS has become a practical and safe therapy in a subgroup of neonates with ductal-dependent pulmonary blood flow.
authors: Department of Pediatric Cardiology, Heart Center, University Hospital of Cologne, Cologne, Germany.
authors: Floris E A
authors: FE
authors: Udink Ten Cate
authors: Narayanswami
authors: N
authors: Sreeram
authors: Hala
authors: H
authors: Hamza
authors: Hala
authors: H
authors: Agha
authors: Eric
authors: E
authors: Rosenthal
authors: Shakeel A
authors: SA
authors: Qureshi
mesh_terms: D001027:Aortography; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D004373:Ductus Arteriosus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004534:Egypt; D005260:Female; D005858:Germany; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008131:London; D008297:Male; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011652:Pulmonary Circulation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: arterial duct; cardiac catheterization; congenital heart disease; intervention; stenting; tortuous duct