DUCTAL STENTING THROUGH LEFT
INTERNAL CAROTID ARTERY IN A 5
YEAR OLD MALE WITH PULMONARY
VALVE ATRESIA: A CASE REPORT
Bee Jane T. Martinez, MD
UP-PGH Department of Pediatrics
Section of Cardiology
To discuss
- ductal stenting and its technique
- ductal stenting compared to mBTS
- different vascular access
GENERAL DATA:
KB, 5/M
Tetralogy of Fallot with Pulmonary
Valve Atresia with a restrictive vertical PDA
supplying the pulmonary arteries
- cyanosis at birth
- 6 to 10 months
- saturations  52% at room air
- mBTS ductal stenting
PHYSICAL EXAMINATION:
• dusky lips, RV heave, loud and
single S2 with no murmur, cyanotic
and clubbed nail beds.
• cyanotic and clubbed nail beds
DIAGNOSTICS
• 2D-echocardiography showed Tetralogy of Fallot
(TOF) with Pulmonary valve atresia (PVA). The
pulmonary arteries were small and confluent and
were supplied by vertical ductus
DIAGNOSTICS
• Angiogram showed vertical ductus supplying small
confluent PAs not accessible for pda stenting from
the femoral arteries
Subclavain
Artery
Internal Carotid
Artery
• Over the past three decades, the technique
of ductal stenting has markedly improved
along side developments in catheter and
stent technology
• Ductal stenting has been almost exclusively
done in newborn infants as a short-term
palliation.
Xu W, Xia C, Zhang Z, et al. Efficacy of arterial duct stenting in
neonatal
pulmonary atresia with intact ventricular
septum. Jul 2011; 39(7): 621-624.
• Vascular access
• Femoral artery, femoral vein, right
axillary or left axillary artery ….
Alwi M. Stenting the ductus arteriosus: Case selection, technique and
possible
complications.
Ann Pediatr
Cardiol.
Jan-Jun 2008;
• Right carotid arteriotomy
…used
in
low
1(1): 38–45
birth weight neonates…
Schneider M, Zartner, Sidiropoulos P, et al. Stent implantation of the
arterialleft
duct
in newborns with duct-dependent circulation.
• In our patient, the
carotid
European Heart Journal. 1998;19: 1401–1409
arteriotomy
• Post ductal stenting, the saturations at room
air increased from a baseline of 52% to 85%
• Post ductal stenting, there was an
LPA
improvement in the degree of blood flow
RPA
toward both PAs.
• The child had a rapid recovery and was
discharged 24 hours after the procedure.
PDA STENTING
mBTS
P40, 000
P120,000170,000
P40,000
P200,000
2 days
5-7 days
Bleeding, stent
occlusion
Scarring,
adhesions,
bleeding, shunt
occlusion,
phrenic nerve
injury,
Cost
Charity
Pay
Duration of hospital
stay
Complications
• ductal stenting in older children, like
those in neonates, can also be safely and
effectively performed as an alternative to
mBTS
• unique technique with low complication
rates
• hospital stay of the patient was shorter in
ductal stenting compared with mBTS
THANK YOU