Arterial duct stenting in low-weight newborns with duct-dependent pulmonary circulation.

OBJECTIVES

To evaluate feasibility and results of arterial duct (AD) stenting in low-weight newborns with congenital heart disease and duct-dependent pulmonary circulation (CHD-DPC).

BACKGROUND

AD stenting is nowadays considered a cost-effective alternative to surgical shunt in CHD-DPC. This option might be even more advisable in low-weight neonates (<2.5 kg), who are at higher surgical risk and in whom stent redilation might adapt shunt magnitude to patient's growth.

METHODS

Between April 2003 and September 2010, 76 neonates with CHD-DPC underwent AD stenting at our institution, as lower-risk palliation with respect to surgical shunt. Procedural and follow-up data of the 15 low-weight newborns (2.0 ± 0.3 kg, median 2.2) (group I) were compared with the remaining normal-weight newborns (3.5 ± 0.7 kg, median 3.2) (group II).

RESULTS

Feasibility, complication rate, and need for surgical shunt did not significantly differ between groups. Global X-ray exposure was significantly higher in the low-weight group (82 ± 108 vs. 30 ± 33 Gray/cm(2) , P < 0.002), which maybe due to a longer angiographic presenting work-up. In-hospital mortality rate was 14.3% (vs. 1.9% in the group II, P = NS), although none of the fatalities was procedure-related. During follow-up, five patients (35.7% vs. 15.7% in the group II, P = NS) underwent stent redilation before surgical repair. At control angiography, the Nakata and McGoon indexes had significantly increased (P < 0.05 for both comparisons), without any significant difference with the group II (162 ± 52% vs. 144 ± 158% and 40 ± 17% vs. 42 ± 38%, P = NS).

CONCLUSIONS

AD stenting is also feasible and effective in low-weight newborns with CHD-DPC, supporting the spontaneous improvement process or promoting a significant pulmonary artery growth.