Pulmonary Artery Growth Following Arterial Duct Stenting in Congenital Heart Disease With Duct-Dependent Pulmonary Circulation

The aim of this study was to assess the pulmonary artery (PA) growth following arterial duct (AD) stenting in neonates with congenital heart disease (CHD) with duct-dependent pulmonary circulation. Background: AD stenting is increasingly deemed as a reliable alternative to surgical shunt in CHD with duct-dependent pulmonary circulation. Allowing the stent to conform to the PA anatomy might avoid any unbalance of lung perfusion and promote a uniform growth of the main PAs. Methods: Of the 47 neonates and infants submitted to AD stenting as palliation of CHD with duct-dependent pulmonary circulation at our Institution, 15 underwent angiographic evaluation of the PA development before surgical repair due to progressive decrease of the systemic oxygen saturation. The Nakata and McGoon indexes as well as the left-to-right PA diameter ratio were considered as being indicative of global and balanced growth. Results: Ductal stabilization was achieved with coronary stents dilated to 3.3 +/- 0.4 mm (range 2.5-4). The control angiography was performed 7 +/- 3 months (range 3-13) after the stenting procedure. At that time, the Nakata and McGoon indexes had significantly increased from 132 +/- 67 to 287 +/- 94 mm/m(2) and from 1.6 +/- 0.3 to 2.1 +/- 0.2 mm/m(2), respectively (P < 0.0001 for both comparisons), due to uniform vascular growth (left PA z-score from -0.7 +/- 1.6 to 1.4 +/- 1.2; right PA from -0.8 +/- 1.4 to 1.4 +/- 1.2, P < 0.0001 for both comparisons; final left-to-right PA ratio 0.9 +/- 0.1). Conclusions: Percutaneous AD stabilization with highly flexible coronary stents is effective in promoting a significant and balanced growth of the PAs in CHD with duct-dependent pulmonary circulation. (C) 2009 Wiley-Liss, Inc.