Hesari Marjan, Ng'eno Mercy, Gordon Brent M, AlShawabkeh Laith, Ryan Justin R, Fulk Clinton, El-Said Howaida
Department of Pediatrics, University of California San Diego, La Jolla, CA, USA.
Rady Children'S Hospital Division of Cardiology, San Diego, San Diego, CA, USA.
Pediatr Cardiol. 2025 May 5. doi: 10.1007/s00246-025-03852-2.
Patent ductus arteriosus (PDA) stenting is an established alternative to systemic-to-pulmonary artery shunts for neonates with ductal-dependent pulmonary blood flow, offering a less invasive approach. However, the procedure remains technically challenging and prone to complications. We evaluated the wire twisting/locking technique to improve precision and safety during PDA stenting. This retrospective study, approved by the UC San Diego Institutional Review Board, analyzed the application of the wire twisting/locking technique for PDA stenting between Jan 2021 and Dec 2024. Data were extracted from electronic medical records, including patient demographics, diagnoses, procedural details, and outcomes. The wire twisting/locking technique was applied in 18 PDA stenting procedures performed on 11 patients with complex cyanotic congenital heart disease. The procedures included initial PDA stenting (n = 10) and PDA stent re-interventions (n = 8), comprising four balloon dilations and four stent placements. The median age of initial stent replacement was 9 days (IQR: 8-90), and the median weight was 3.88 kg (IQR: 3.17-6.05). Access sites included carotid (n = 10), femoral (n = 4), axillary (n = 2), and umbilical arteries (n = 2). The median stent diameter was 2.05 mm (IQR: 1.5-2.4), and the median stent length was 24.35 mm (IQR: 22-30 mm). The median procedure time was 91 min (IQR: 62-130) and a median radiation dose of 154.73 Gycm. All procedures were successful, with no vascular or pulmonary complications. Median discharge oxygen saturation was 85% (IQR: 82-89). The wire twisting/locking technique represents a promising modification for PDA stenting. Utilizing a dynamic soft wire and opting for a single long stent simplifies stent placement and minimizes procedural complications.
动脉导管未闭（PDA）支架置入术是一种成熟的替代方法，用于治疗依赖导管供血的新生儿肺血流，提供了一种侵入性较小的治疗途径。然而，该手术在技术上仍然具有挑战性，并且容易出现并发症。我们评估了钢丝扭转/锁定技术，以提高PDA支架置入术的精度和安全性。这项回顾性研究经加州大学圣地亚哥分校机构审查委员会批准，分析了2021年1月至2024年12月期间钢丝扭转/锁定技术在PDA支架置入术中的应用情况。数据从电子病历中提取，包括患者人口统计学信息、诊断、手术细节和结果。钢丝扭转/锁定技术应用于11例患有复杂紫绀型先天性心脏病患者的18例PDA支架置入手术中。这些手术包括初次PDA支架置入术（n = 10）和PDA支架再次干预（n = 8），其中包括4次球囊扩张和4次支架置入。初次支架置换的中位年龄为9天（四分位间距：8 - 90），中位体重为3.88千克（四分位间距：3.17 - 6. .05）。穿刺部位包括颈动脉（n = 10）、股动脉（n = 4）、腋动脉（n = 2）和脐动脉（n = 2）。中位支架直径为2.05毫米（四分位间距：1.5 - 2.4），中位支架长度为24.35毫米（四分位间距：22 - 30毫米）。中位手术时间为91分钟（四分位间距：62 - 130），中位辐射剂量为154.73 Gycm。所有手术均成功，无血管或肺部并发症。出院时的中位血氧饱和度为85%（四分位间距：82 - 89）。钢丝扭转/锁定技术是PDA支架置入术的一种有前景的改良方法。使用动态软钢丝并选择单个长支架可简化支架置入并将手术并发症降至最低。
