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Citation: Ruiz-Ontiveros MA , Montalvo-Aguilar J, Flores-Arizmendi A, Salgado-Sandoval A. Recanalization of a closed Ductus Arterious using
carotidian approach: A case report and literature review. Jr. med. res. 2023; 6(2):14-16. Ruiz-Ontiveros et al © All rights are reserved
https://doi.org/10.32512/jmr.6.2.2023/14.16 Submit your manuscript:www.jmedicalresearch.com
Case Report
Ruiz-Ontiveros Marco Antonio
1
, Montalvo-Aguilar Jesus
1
*, Flores-Arizmendi Alejandro
1
, Salgado-Sandoval Antonio
1
.
Recanalization of a closed Ductus Arteriosus using carotidian approach: A case report.
1: Department of Interventional Pediatric
Cardiology, National Medical Center 20 de
Noviembre ISSSTE, Mexico City
* Corresponding author
Correspondence to:
dragones27@hotmail.com
Publication Data:
Submitted: July 23,2023
Accepted: September 19,2023
Online: November 30,2023
This article was subject to full peer-review.
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Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. It
may be associated with anomalies of the aortic arch and pulmonary branches. In
neonatal period, percutaneous stent placement for the patent Ductus arteriosus
(PDA) is a safe alternative to surgical treatment in cyanotic duct-dependent heart
conditions. We herein report the case of a nine-month-old female patient presenting
with rare association of Tetralogy of Fallot, absence of the left pulmonary branch,
right aortic arch and subaortic innominate vein. Ductus arteriosus was recanalized
lately using percutaneous carotidian approach.
Keywords
Congenital heart disease; Duct-dependent pulmonary circulation; Patent ductus arteriosus; stent.
Introduction
Stenting of patent ductus arteriosus (PDA) as first stage palliation in duct-dependent
pulmonary circulation is an effective procedure in neonates and young infants as an
alternative to surgical shunts. This minimally invasive procedure may reduce shunt-
related sequelae that increase the morbimortality of subsequent corrective surgical
procedures [1].
Observation
We present the case of a nine-month-old female patient presenting with tetralogy of
Fallot associated to absent left pulmonary branch, right aortic arch and subaortic
innominate vein. During cardiac catheterization, only the main and right pulmonary
arteries were observed (figure 1). Singh maneuver was performed with retrograde
injection of the left superior pulmonary vein.The existence of adequately sized left
pulmonary branch was confirmed (Z+2.6).
In the aortic arch, there was no evidence of ductus arteriosus. However, a ductal
ampulla was seen without progression of contrast(figure 1). Catheterization with
coronary guide towards the pulmonary branch showed the continuity and the ductus
was opacified. Due to the position of the duct, it was decided to access through the
right carotid with JR catheter 6Fr and coronary guide until it was placed in the lower
left lobar, subsequently a plasty was performed at the ductus site with a 2.5x20mm
balloon. A4.5x16 mm coronary stent was placed at the level of the ductus, achieving
patency towards the left pulmonary branch. Hours after the procedure, findings of
reperfusion in the left lung were noticed. The patient was managed in PICU. Forty-
eight hours later, echocardiographic and tomographic control showed a decrease in
the stent’s lumen diameter (figure 2).
New catheterization was indicated. Ultrasound-guided right carotid access was again
obtained with JR catheter 5Fr the coronary guide was placed in the lower left lobar.
A4.5x16mm stent was placed inside the previous one and a second plasty was
performed. The angiographic control performed showed adequate flow through the
ductus arteriosus to the left pulmonary branch (figure 3).
Postoperative course was uneventful, and the patient was discharged the first week.
Regular clinical and radiological follow showed no complications, and the patient is
scheduled for total correction.
Abstract
Recanalization of a closed Ductus Arteriosus using carotidian approach: A case report
Citation: : Ruiz-Ontiveros MA , Montalvo-Aguilar J, Flores-Arizmendi A, Salgado-Sandoval A. Recanalization of a closed Ductus Arterious using
carotidian approach: A case report and literature review. Jr. med. res. 2023; 6(2):14-16. Ruiz-Ontiveros et al © All rights are reserved
Submit your manuscript: www.jmedicalresearch.com.
Figure 1: A: evidence of no continuity from the PA to the LPA. B: a closed ampulla in the origin of the LSA (arrow)
Figure 2: angio-CT showing stent position from the origin of LSA to the Left pulmonary artery.
Figure 3: A: Stent placement in the ductus. B: Post-recanalization effusion
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Recanalization of a closed Ductus Arteriosus using carotidian approach: A case report
Citation: : Ruiz-Ontiveros MA , Montalvo-Aguilar J, Flores-Arizmendi A, Salgado-Sandoval A. Recanalization of a closed Ductus Arterious using
carotidian approach: A case report and literature review. Jr. med. res. 2023; 6(2):14-16. Ruiz-Ontiveros et al © All rights are reserved
Submit your manuscript: www.jmedicalresearch.com.
Conflict of Interest: None
References
[1] Boucek DM, Qureshi AM, Goldstein BH, Petit CJ, Glatz AC. Blalock-Taussig shunt versus patent ductus arteriosus stent as first palliation for ductal-dependent pulmonary circulation lesions: A review of the literature.
Congenit Heart Dis. 2019; 14:105-109.
[2] Wespi R, Callegari A, Quandt D, Logoteta J, von Rhein M, Kretschmar O, et al. Favourable short- to mid-term outcome after PDA-stenting in duct-dependent pulmonary circulation. Int J Environ Res Public Health.
2022; 19:12794.
[3] Agha HM, Abd-El Aziz O, Kamel O, Sheta SS, El-Sisi A, El-Saiedi S, et al. Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. PLoS One. 2022;17: e0265031.
[4] Płużańska J, Ostrowska K, Moll J, Dryżek P, Moszura T. PDA stenting in 6-month-old infant with suprasystemic pulmonary hypertension as a treatment option for hypertensive crisis. Postepy Kardiol Interwencyjnej.
2019; 15:371-73.
[5] Garg G, Mittal DK. Stenting of patent ductus arteriosus in low birth weight newborns less than 2kg- procedural safety, feasibility and results in a retrospective study. Indian Heart J. 2018; 70:709-12.
[6] Nasser BA, Abdulrahman M, Qwaee AAL, Alakfash A, Mohamad T, Kabbani MS. Impact of stent of ductus arteriosus and modified Blalock-Taussig shunt on pulmonary arteries growth and second-stage surgery in
infants with ductus-dependent pulmonary circulation. J Saudi Heart Assoc. 2020 17; 32:86-92.
[7] Bahaidarah S, Al-Ata J, Alkhushi N, Azhar A, Zaher Z, Alnahdi B, et al. Outcome of ductus arteriosus stenting including vertical tubular and convoluted tortuous ducts with emphasis on technical considerations.
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Discussion
cyanotic congenital heart disease patients are generally dependent on alternative sources of pulmonary blood flow (PBF) such
as a patent ductus arteriosus (PDA) [2,3]. Most of these patients need palliative procedure to ensure sufficient PBF until
definitive corrective surgery. The emergence of percutaneous PDA stenting has significantly decreased the morbimortality of
surgical palliative procedures and contributed to objective enhancement of the prognosis of these cardiopathies [4]. As a less
invasive method for palliative maintenance, percutaneous PDA stenting showed better feasibility in risky cases, shorter
intensive care unit and hospital length of stays and lower complication rates. PDA stenting for patients with duct-dependent
pulmonary circulation has lower mortality rates than systemic-pulmonary surgical shunt procedure [5-7].
Our case was technically challenging because of the delay of the intervention (>6months), the impossibility of visualization of
the ductus and variant ductal ampulla disposition. The successful use of the carotid approach may propose a safe and effective
alternative to the femoral access point. The outcome of this procedure is dependent of PDA origin and morphology. Stenting of
younger patients with straight and large PDA at the pulmonary end has significantly higher successful procedure rate.
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