Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany.
Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, D-81377 Munich, Germany.
Int J Cardiol. 2019 Jun 15;285:103-107. doi: 10.1016/j.ijcard.2019.01.062. Epub 2019 Jan 25.
Stenting of the patent ductus arteriosus (PDA) has been accepted as alternative option to surgical shunting to enable additional pulmonary blood flow or for palliation of patients with a truly duct-dependent pulmonary circulation. The procedure can be challenging given the variable and often tortuous anatomy of the PDA and various technical approaches are reported.
To report an alternative technique to treat tortuous ducts with microcatheter assistance and by transfemoral approach.
We applied this technique of PDA stenting in 5 consecutive patients (4/5 age < 1 week, weight 2,7-3,2 kg; 1/5 re-do PDA stenting at 6,5 month and 5,9 kg). A soft coronary guidewire was advanced by microcatheter assistance into the branch pulmonary arteries and thereafter replaced by an extrastiff guidewire to enable the placement of long coronary stents.
Successful PDA stenting with this stepwise approach and with femoral access only could be achieved in all patients (n = 5/5). A single stent was used in 2 patients (one with re-do stenting and previous stents). 3/5 patients had 2 stents implanted by telescopic technique. Stent sizes used were 4,5 × 15 mm (n = 2) and 4,5 × 18 mm (n = 6). No guide wire or stent dislodgement appeared through all procedures with microcatheter assistance.
This technique enables PDA stenting via transfemoral approach in complex and tortuous ducts and thereby offers an attractive addition to the interventional management of truly duct-dependent pulmonary circulation.
动脉导管未闭（PDA）支架置入术已被接受为替代手术分流的选择，以增加肺血流量或缓解真正依赖导管的肺循环患者的症状。由于 PDA 的解剖结构多变且通常扭曲，因此该手术具有挑战性，并且有各种技术方法报道。
报告一种通过微导管辅助和经股动脉入路治疗迂曲导管的替代技术。
我们在 5 例连续患者（4/5 年龄<1 周，体重 2.7-3.2kg；1/5 患者为 6.5 月龄和 5.9kg 时再次进行 PDA 支架置入术）中应用了这种 PDA 支架置入技术。通过微导管辅助将软冠状动脉导丝推进到肺动脉分支，然后用超硬导丝替换，以能够放置长冠状动脉支架。
所有患者（n=5/5）均成功通过逐步方法和股动脉入路进行了 PDA 支架置入。2 例患者（1 例为再次支架置入术且有先前的支架）使用了 1 个支架。3/5 例患者通过伸缩技术植入了 2 个支架。使用的支架尺寸为 4.5×15mm（n=2）和 4.5×18mm（n=6）。所有带微导管辅助的手术过程中都没有出现导丝或支架移位的情况。
该技术可通过经股动脉入路在复杂和迂曲的导管中进行 PDA 支架置入，从而为真正依赖导管的肺循环的介入治疗提供了一种有吸引力的选择。
