Dalby Stephen, Ehsan Lubaina, Dossey Amy, Greiten Lawrence, Angtuaco Michael
Arkansas Children's Hospital, Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA.
University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Pediatr Cardiol. 2025 Jan 21. doi: 10.1007/s00246-025-03779-8.
Patent ductus arteriosus (PDA) stenting is a vital intervention for neonates with ductal-dependent blood flow, offering an attractive alternative to surgical shunt placement. Despite its benefits, the procedure poses risks such as ductal spasm, branch pulmonary artery compromise, and pseudoaneurysm formation. This report presents two complex neonatal cases with distinct outcomes. The first patient experienced severe ductal spasm, pseudoaneurysm formation, and ductal dissection. Innovative use of percutaneous venovenous extracorporeal membrane oxygenation (VV ECMO) provided hemodynamic stability, enabling staged interventions and eventual successful ductal stenting. The second patient experienced acute left pulmonary artery flow loss due to ductal spasm. Transcatheter attempts to restore flow failed, necessitating surgical stent removal and Blalock-Taussig-Thomas shunt placement. These cases highlight the challenges of PDA stenting in complex ductal anatomies and the importance of advanced imaging, careful wire and catheter selection, and multidisciplinary collaboration. Notably, the first reported use of percutaneous VV ECMO during PDA stenting demonstrates its potential as a lifesaving adjunct for these cases.
动脉导管未闭（PDA）支架植入术是对依赖动脉导管血流的新生儿的重要干预措施，为手术分流放置提供了有吸引力的替代方案。尽管有其益处，但该手术存在诸如导管痉挛、分支肺动脉受压和假性动脉瘤形成等风险。本报告介绍了两例结局不同的复杂新生儿病例。首例患者出现严重导管痉挛、假性动脉瘤形成和导管夹层。经皮静脉-静脉体外膜肺氧合（VV ECMO）的创新应用提供了血流动力学稳定性，使得能够进行分期干预并最终成功进行导管支架植入。第二例患者因导管痉挛出现急性左肺动脉血流丧失。经导管恢复血流的尝试失败，需要手术取出支架并放置Blalock-Taussig-Thomas分流。这些病例突出了在复杂导管解剖结构中进行PDA支架植入术的挑战以及先进成像、仔细选择导丝和导管以及多学科协作的重要性。值得注意的是，首次报道在PDA支架植入术中使用经皮VV ECMO证明了其作为这些病例挽救生命辅助手段的潜力。
