Section of Pediatric Cardiology Tulane University, Tulane University Hospital for Children New Orleans, Louisiana.
Catheter Cardiovasc Interv. 2013 Oct 1;82(4):519-25. doi: 10.1002/ccd.25019. Epub 2013 Jun 14.
To describe patent ductus arteriosus (PDA) stenting regardless of ductal morphology in high risk patients with hypoplast physiology undergoing hybrid stage I palliation (PDA stenting and placement of bilateral pulmonary artery bands).
Hybrid palliation is an accepted alternative for patients with hypoplastic left heart syndrome. Patients weighing less than 2.5 kg, history of prematurity, intracranial hemorrhage, and chromosomal abnormality belong to a high-risk group who otherwise might not be ideal candidates for traditional surgical repair (Norwood Operation).
Between May 2005 and February 2013, a series of 13 high-risk patients with hypoplast physiology with varying types of ductal morphology underwent PDA stenting as part of hybrid stage I palliation.
Three major types of ductal morphology were identified: (1) short and semi horizontal, (2) long and semi horizontal, and (3) tortuous. All patients underwent successful PDA stenting. One patient developed proximal coarctation from inadequate coverage of the pulmonary end of the PDA and was successfully treated with a balloon expandable stent 69 days after the initial procedure.
Mid- to long-term follow-up indicates that PDA stents remain widely patent regardless of ductal morphology until comprehensive stage II repair.
描述动脉导管未闭（PDA）支架置入术，无论高危患者的动脉导管形态如何，这些患者都存在低心排量生理学，需要接受杂交一期姑息治疗（PDA 支架置入术和双侧肺动脉带放置）。
杂交姑息治疗是一种可接受的选择，适用于患有左心发育不全综合征的患者。体重小于 2.5kg、早产史、颅内出血和染色体异常的患者属于高危组，否则可能不适合传统的手术修复（Norwood 手术）。
2005 年 5 月至 2013 年 2 月，一系列低心排量生理学的高危患者，伴有不同类型的动脉导管形态，接受了 PDA 支架置入术作为杂交一期姑息治疗的一部分。
确定了三种主要的动脉导管形态：（1）短而半水平，（2）长而半水平，和（3）迂曲。所有患者均成功进行了 PDA 支架置入术。1 名患者因 PDA 肺动脉端覆盖不足而发生近端缩窄，在初始手术后 69 天成功接受了球囊扩张支架治疗。
中期至长期随访表明，无论动脉导管形态如何，PDA 支架在接受全面二期修复之前都保持广泛通畅。
