DUCTAL STENTING THROUGH LEFT INTERNAL CAROTID ARTERY IN A 5

YEAR OLD MALE WITH PULMONARY VALVE ATRESIA: A CASE REPORT

Bee Jane T. Martinez, MDUP-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

DIAGNOSTICSDIAGNOSTICS• 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

DIAGNOSTICSDIAGNOSTICS•Angiogram showed vertical ductus supplying small

confluent PAs not accessible for pda stenting from

the femoral arteries

Internal Carotid Artery

Subclavain 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 …. • Right carotid arteriotomy …used in low

birth weight neonates…• In our patient, the left carotid

arteriotomy

Alwi M. Stenting the ductus arteriosus: Case selection, technique and possible complications. Ann Pediatr Cardiol. Jan-Jun 2008;

1(1): 38–45

Schneider M, Zartner, Sidiropoulos P, et al. Stent implantation of the arterial duct in newborns with duct-dependent circulation. European Heart Journal. 1998;19: 1401–1409

• Post ductal stenting, the saturations at room air increased from a baseline of 52% to 85%

• Post ductal stenting, there was an improvement in the degree of blood flow toward both PAs.

• The child had a rapid recovery and was discharged 24 hours after the procedure.

LPA

RPA

PDA STENTING mBTS

Cost Charity Pay

P40, 000P120,000-170,000

P40,000P200,000

Duration of hospital stay

2 days 5-7 days

Complications Bleeding, stent occlusion

Scarring, adhesions,

bleeding, shunt occlusion,

phrenic nerve injury,

• 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