title: Morphology of the patent ductus arteriosus does not preclude successful patent ductus arteriosus stent implantation in high-risk patients undergoing hybrid stage I palliation: recommendations to optimize ductal stent positioning.
abstract: OBJECTIVE
  To describe patent ductus arteriosus (PDA) stenting regardless of ductal morphology in high risk patients with hypoplast physiology undergoing hybrid stage I palliation (PDA stenting and placement of bilateral pulmonary artery bands).
  
  
  BACKGROUND
  Hybrid palliation is an accepted alternative for patients with hypoplastic left heart syndrome. Patients weighing less than 2.5 kg, history of prematurity, intracranial hemorrhage, and chromosomal abnormality belong to a high-risk group who otherwise might not be ideal candidates for traditional surgical repair (Norwood Operation).
  
  
  METHODS
  Between May 2005 and February 2013, a series of 13 high-risk patients with hypoplast physiology with varying types of ductal morphology underwent PDA stenting as part of hybrid stage I palliation.
  
  
  RESULTS
  Three major types of ductal morphology were identified: (1) short and semi horizontal, (2) long and semi horizontal, and (3) tortuous. All patients underwent successful PDA stenting. One patient developed proximal coarctation from inadequate coverage of the pulmonary end of the PDA and was successfully treated with a balloon expandable stent 69 days after the initial procedure.
  
  
  CONCLUSIONS
  Mid- to long-term follow-up indicates that PDA stents remain widely patent regardless of ductal morphology until comprehensive stage II repair.
authors.affiliation: Section of Pediatric Cardiology Tulane University, Tulane University Hospital for Children New Orleans, Louisiana.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Recto
authors.forename: Sandy
authors.initials: S
authors.lastname: Doyle
authors.forename: Vitor C
authors.initials: VC
authors.lastname: Guerra
authors.forename: Song Gui
authors.initials: SG
authors.lastname: Yang
authors.forename: Thomas
authors.initials: T
authors.lastname: Yeh
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D003131:Combined Modality Therapy; D004374:Ductus Arteriosus, Patent / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000628:therapy*; D007231:Infant, Newborn; D008026:Ligation; D008297:Male; D010166:Palliative Care; D011651:Pulmonary Artery / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
keywords: hypoplastic left heart syndrome; pediatric intervention; pulmonary angiography; stent structure