title: Creation of a functional Potts shunt by stenting the persistent arterial duct in newborns and infants with suprasystemic pulmonary hypertension of various etiologies.
abstract: BACKGROUND
  The surgical creation of a Potts shunt has been reported in children with suprasystemic idiopathic pulmonary artery (PA) hypertension (IPAH) refractory to any medical therapy. This surgical approach allows acute decompression of the right ventricle (RV) and thereby avoids ventricular failure. We present 4 newborns and infants with different causes of pulmonary hypertension (PH) in whom interventional stenting of the patent ductus arteriosus (PDA) was used to create a "functional" Potts shunt.
  
  
  METHODS
  Suprasystemic PH was diagnosed by cardiac catheterization in 2 newborns with complex left heart obstructive lesions, a patient with persistent PH of the newborn (PPHN), and an infant with IPAH and was accompanied by RV dilation and imminent RV failure.
  
  
  RESULTS
  Stenting of the PDA was performed uneventfully during cardiac catheterization in all patients and led to stabilization of clinical symptoms. The 2 patients with complex cardiac lesions subsequently underwent successful biventricular repair. In the PPHN patient, the stented PDA was closed interventionally when PA pressures dropped and a significant left-to-right shunt occurred. PA pressures in the patient with IPAH remained high while the stented PDA still served as RV decompression in avoidance of lung transplantation.
  
  
  CONCLUSIONS
  Newborns and infants with suprasystemic PH of varying etiologies may benefit from the creation of a functional Potts shunt by stenting the PDA. This strategy should be considered in patients with suprasystemic IPAH or PPHN as a temporary or permanent therapy when a PDA can be identified at cardiac catheterization. It may also be beneficial in patients with PH due to left heart obstructions by serving as a bridge to further corrective surgery.
authors.affiliation: Pediatric Heart Center, Justus-Liebig University, Giessen, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Latus
authors.affiliation: Pediatric Heart Center, Justus-Liebig University, Giessen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Apitz
authors.affiliation: Pediatric Heart Center, Justus-Liebig University, Giessen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Moysich
authors.affiliation: Pediatric Heart Center, Justus-Liebig University, Giessen, Germany.
authors.forename: Gunter
authors.initials: G
authors.lastname: Kerst
authors.affiliation: Pediatric Heart Center, Justus-Liebig University, Giessen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jux
authors.affiliation: Pediatric Heart Center, Justus-Liebig University, Giessen, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Bauer
authors.affiliation: Pediatric Heart Center, Justus-Liebig University, Giessen, Germany. Electronic address: dietmar.schranz@paediat.med.uni-giessen.de.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Schranz
mesh_terms: D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D011651:Pulmonary Artery / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents
keywords: Potts shunt; pulmonary hypertension; stenting the persistent arterial duct