Rehman Rizwan, Marhisham Mood Che, Alwi Mazeni
Department of Pediatric Cardiology, Institut Jantung Negara (National Heart Institute) 50400 Kuala Lumpur, Malaysia.
Future Cardiol. 2018 Jan;14(1):55-73. doi: 10.2217/fca-2017-0053. Epub 2017 Dec 4.
Patent ductus arteriosus (PDA) stenting has gained acceptance for palliation in cyanotic congenital heart disease. The PDA in tetralogy of Fallot with pulmonary atresia (ToF-PA) arises, in the left aortic arch, from underneath the arch and connects to the proximal left pulmonary artery, often resulting in stenosis. The PDA is usually elongated and tortuous, making stent implantation challenging. Shorter duration of palliation, aggravation of branch pulmonary artery stenosis resulting in poor growth and difficulty at surgery makes ductal stenting controversial. Access via the carotid and axillary artery reduces complexity of the procedure and improves success, with recent data demonstrating good pulmonary artery growth. Advances in bioresorbable stents offer future promise and will likely resolve some controversies surrounding PDA stenting in ToF-PA.
动脉导管未闭（PDA）支架置入术已被用于治疗青紫型先天性心脏病。法洛四联症合并肺动脉闭锁（ToF-PA）患者的PDA起源于左主动脉弓下方，连接至左肺动脉近端，常导致狭窄。PDA通常细长且迂曲，使得支架植入具有挑战性。姑息治疗时间较短、分支肺动脉狭窄加重导致生长发育不良以及手术困难，使得导管支架置入术存在争议。经颈动脉和腋动脉途径可降低手术复杂性并提高成功率，近期数据表明肺动脉生长良好。生物可吸收支架的进展带来了未来的希望，可能会解决一些围绕ToF-PA中PDA支架置入术的争议。
