PDA Stenting Using a 3.3 French System: A Further Step to Miniaturization

Background: PDA stenting is a technically feasible and effective palliation in congenital heart disease with duct-dependent pulmonary circulation. Serious complications can result from arterial access by the introduced sheath. Smaller sheath sizes could result in reduction of vessel injuries.

Method: We report hereby our experience using a 3.3 French (Fr) system. The introducer sheath has an inner diameter of 3.3 Fr (1.1 mm) and outer diameter of 1.7 mm. The guidewire has a diameter of 0.018 inch. Catheterization was performed by using a 3.3-Fr JR catheter (25-inch guidewire). For PDA stenting bare metal coronary stents were used ranging from 3 mm × 9 mm to 4 mm × 22 mm with a maximum shaft size of 2.7 Fr.

Results: From 2019 to August 2021, 95 PDA stenting procedures were performed, thereof in nine patients via a 3.3-Fr sheath system. Mean weight was 2.3  ± 0.47 (1.5–3.0) kg, median age at intervention of 8 days. The underlying congenital heart disease were: tricuspidatresia with pulmonary stenosis (PST), L-TGA with PST, two d-TGA in premature infants, two pulmonary atresia (PAT) with VSD, one PAT with IVS, one critical PST, and one imbalanced AVSD with severe PST. Arterial access was performed in eight of nine cases via femoral artery, and in one case via axillary artery. Three patients required reopening of the arterial duct prior to stent implantation using various wires followed by balloon dilation performed with low profile balloons (1.5 mm × 15 mm to 3 mm × 15 mm). In two patients, two stents were implanted to cover the entire length of the duct. Two patients underwent a second procedure for balloon dilatation due to instent stenosis, one patient required the implantation of a second stent. In one patient, the implanted stent embolized into the pulmonary artery and subsequently underwent surgery without further problems. None of the patients had vessel-associated complications.

Conclusion: PDA Stenting using a 3.3-Fr system is feasible and safe and can reduce the risk of arterial vessel trauma, especially in small infants (<3 kg).

Publication History

Article published online:
12 February 2022