PDA Stenting in Duct-Dependent Pulmonary Circulation
Surgical aortopulmonary shunts palliate neonates with duct-dependent pulmonary circulation. The surgical problems included prolonged mechanical ventilation and intensive care stays, bleeding and transfusions, frequent use of multiple inotropes, pulmonary complications, sepsis, and injury to surrounding structures like the phrenic nerve, recurrent laryngeal nerve, and thoracic duct. Ductal stenting (DS) provides a nonsurgical attractive alternative option to surgical aortopulmonary shunts. On follow-up after both these procedures, there is a progressive fall in oxygen levels due to intimal ingrowth within the ductal stents and fibrointimal peel formation and thrombus within surgical shunts. Five to twenty percent of patients suddenly die on follow-up due to shunt or stent thrombosis. While the surgical shunts offer a longer palliation of few years, DS gives longevity of only 6–12 months. This difference in duration of palliation will influence patient selection for DS.