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Vol. 73. Issue 7.
Pages 578 (July 2020)
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Vol. 73. Issue 7.
Pages 578 (July 2020)
Image in cardiology
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Ductal stenting and pulmonary artery stenosis
Stent ductal y estenosis de arterias pulmonares
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Pedro Betrián Blascoa,
Corresponding author
pedrobetrian@yahoo.es

Corresponding author:
, Gerard Marti Aguascab, Queralt Ferrer Menduiñac
a Servicio de Cardiología Pediátrica, Unidad de Cardiología Intervencionista Pediátrica, Hospital Universitario Vall d’Hebron, Barcelona, Spain
b Servicio de Cardiología, Sección de Cardiología Intervencionista, Unidad de Cardiología Intervencionista de Cardiopatías Congénitas del Adulto, Hospital Universitario Vall d’Hebron, Barcelona, Spain
c Servicio de Cardiología Pediátrica, Unidad de Cardiología Fetal y Neonatal, Hospital Universitario Vall d’Hebron, Barcelona, Spain
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The patient was a male neonate weighing 2200g, with a single-ventricle defect, pulmonary atresia, ductus-dependent pulmonary flow, and severe stenosis at the point of union between the ductus and pulmonary arteries. Given the patient's low weight and anatomical complexity, a percutaneous intervention was chosen.

During catherization, ostial stenosis of the pulmonary arteries was confirmed (figure 1, computed tomography angiography; figure 2, aortography: Ao [aorta], grey arrow [ductus], white arrow [branch stenosis]; video 1 of the supplementary data). Bifurcation coronary stenting (Culotte technique) was chosen to maintain the ductus open and resolve the pulmonary artery stenosis.

Figure 1
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Figure 2
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With a 4-Fr introducer from the carotid artery to provide greater support (an anterograde mammary guiding catheter would have provided insufficient support), an Onyx 3.5×15mm stent was implanted between the aorta, ductus, and left branch, and cells were opened towards the right pulmonary artery. A second 3.5×15mm stent was placed in the aorta, ductus, and right pulmonary artery, opening cells towards the left pulmonary artery. Subsequently, sequential dilatations were performed in both arteries. Finally, the ductal segment of the stent was dilated with a 4mm balloon (the ductal diameter regulates the pulmonary flow and is determined by the weight of the neonate), with a good angiographic outcome (figure 3 and video 2 of the supplementary data).

Figure 3
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Stent placement in the ductus arteriosus is an established technique to correct heart defects with reduced pulmonary flow. Normally, only the ductus is covered and cases of stenosis of associated branches are ruled out. In this case, novel use of a percutaneous coronary intervention underpinned the success of the procedure.

APPENDIX. SUPPLEMENTARY DATA

Supplementary data associated with this article can be found in the online version available at https://doi.org/10.1016/j.rec.2019.10.014

Copyright © 2019. Sociedad Española de Cardiología
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Revista Española de Cardiología (English Edition)

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