Ductal Stenting in Double Aortic Arch with Tetralogy of Fallot and Pulmonary Atresia: Challenges and Imaging Aspects.

Patent ductus arteriosus (PDA) stenting is a safer alternative to palliative cardiac surgery for newborns with duct-dependent or diminished pulmonary circulation. However, its application in patients with aortic arch abnormalities poses unique challenges. The rare combination of tetralogy of Fallot (TOF) with pulmonary atresia and a double aortic arch (DAA) has been infrequently reported. This case report insights a 1-month-old male infant with a chromosome 22q11 deletion who presented acutely with severe cyanosis with an initial diagnosis of TOF with pulmonary atresia and a right-sided aortic arch. Emergency ductal stenting was performed using a 4.5 mm × 12 mm coronary stent, during which a DAA was unexpectedly revealed. We discuss the technical challenges and difficulties encountered during the PDA stenting procedure due to this unique anatomical combination, along with the successful postoperative outcome. In this case report, we also emphasize the vital role of advanced three-dimensional imaging in guiding future interventions and intracardiac repairs.