Normal heart
Pulmonary atresia with intact ventricular septum
The communication between the right ventricle and the pulmonary artery is closed. Blood goes from the right heart to the left heart through the foramen ovale. The ductus arteriosus is the only source of vascularization of the pulmonary circulation.
Coronary stent
Actual size of a stent used to keep the ductus arteriosus open.
DUCTUS ARTERIOSIS STENTING
in the newborn
What is the ductus arteriosus?
The ductus arteriosus is a normal connection between the aorta and the pulmonary artery in the fetus, allowing blood to bypass the lungs and go directly to its organs. However, after birth, blood must be oxygenated by the lungs, and the ductus arteriosus closes quickly, usually within a few days to two weeks.
In some congenital pathologies (such as the example on the right of pulmonary atresia with intact ventricular septum ) affecting the pulmonary circulation, the lungs do not receive enough blood flow which causes desaturation in the newborn with a risk of death in the very short term. The ductus arteriosus then allows to maintain a sufficient supply of blood flow to the pulmonary circulation. To keep it open, stenting of the ductus arteriosus can be proposed.
So why is ductus arteriosus stenting proposed?
There are three ways to maintain sufficient flow to the pulmonary circulation:
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drug method: prostaglandin infusion. The advantage is the absence of invasive procedures. The disadvantage is the countless side effects of the medication. It is not advisable to leave it for more than a week.
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Interventional method: stenting of the ductus arteriosus. The advantage is that it is an invasive procedure without surgery. The disadvantage is the complications of the femoral arterial route.
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Surgical method: Blalock surgery. The advantage is that it is the oldest method. The disadvantage is the complications of surgery.
Stenting of the ductus arteriosus in surgically risky situations may be the best alternative.
Procedure for Stenting the Arterial Duct:
The examination takes place in the interventional cardiology unit. The child is laid flat and placed under general anesthesia to prevent movement during the procedure. The doctor performs an arterial puncture in the groin area and inserts a thin catheter. The catheter is guided to the heart. The stent is deployed in the arterial duct to keep it open. At the end of the procedure, pressure is applied to the groin area for about ten minutes, and a compressive bandage is placed. The child is monitored in the recovery room until they fully regain consciousness and are then returned to their parents. Feeding is only allowed two hours after the end of the procedure.
What are the complications of a ductus arteriosus stenting procedure?
Despite the experience of the operators and the significant technical progress concerning catheters and prostheses, this is an invasive procedure involving risks:
allergic complications most often linked to the use of anesthesia products.
Vascular complications at the femoral puncture site: the most common is a hematoma, which results in a bluish appearance that is usually harmless and disappears after a few days. Sometimes, a vascular injury may require surgical repair or transfusion. Thrombosis of the artery may also occur.
Complications leading to death : They are not rare, but the natural evolution of these pathologies leads to death in the very short term in the absence of intervention. Stenting remains a life-saving procedure.
What benefits can be expected after ductus arteriosus stenting?
Stenting of the ductus arteriosus allows normal height and weight growth, to be expected for a few months, after the next surgical step of correction of the congenital heart disease.
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