Tagging the Arterial Duct to Facilitate Stenting in Low-birthweight Infants

Objectives: Hybrid palliation in single ventricle lesions consisting of bilateral pulmonary artery banding and stenting the arterial duct is an accepted bridging concept. However, ductal stent positioning may be difficult in certain scenarios, especially preterm and/or low-birthweight infants. We present a simple yet refined technique to facilitate stent placement.

Methods: We report on two premature neonates with duct-dependent systemic circulation: the first patient had hypoplastic left heart syndrome (2.1 kg, 34^th weeks' gestation), the second a truncus arteriosus and an interrupted aortic arch (1.6 kg, 32^nd weeks' gestation). After interdisciplinary discussion, we decided to proceed with a hybrid strategy in both patients due to elevated risk of bypass-surgery. Bilateral pulmonary artery banding (3.0mm Gore-Tex^® tube grafts) was performed in the operating room as usual, supplemented by marking the arterial ducts' pulmonary ends with radiopaque stripes (off-label). Both patients were transported to the catheterization laboratory within 24 hours after chest closure: angiography clarified the ductal arch anatomy in relation to the radiopaque stripe, which was utilized as a proximal ductal landmark prior to stent placement.

Results: Good visibility of the landing zone facilitated stent deployment in a very straightforward manner using short 4 Fr sheaths via transfemoral venous access. In patient one, a self-expandable stent (SuperFlex DS: 7.0/15 mm) and in patient two a balloon-expandable stent (414 Eq. 4.0/12 mm) were implanted. Finally, control angiography revealed quite good results with no restriction. Both infants withstood the maneuver well; hemodynamics was not impaired.

Conclusion: Radiopaque stripes tagging the landing zone for quick, accurate stenting of the arterial duct in high-risk neonates is a promising and refined technique that may enhance safety.