Despite current trends toward primary repair, surgical systemic-to-pulmonary
shunt is still an invaluable palliative option in some patients with congenital heart
defects and duct-dependent pulmonary circulation. However, arterial duct stabilization
with high-flexibility coronary stent could be an effective alternative in high-risk surgical
candidates or whenever a short-term pulmonary blood flow support is anticipated. This
paper highlights history, methods and results of this attractive mini-invasive palliative
approach to cardiac malformation with duct-dependent pulmonary circulation. Based on
ductal origin and morphology, stenting procedure can be perfomed from arterial or
venous route. Following arterial duct angiographic imaging, the stabilizing stent is
chosen to completely cover the entire ductal length and dilated slightly less than the
proposed surgical shunt. Procedural failure mainly depends on ductal tortuosity and
ranges around 10% of cases. Morbidity and mortality are 8-11% and less than 1%,
respectively. Mid-term fate of the stented duct is spontaneous, slow and progressive
closure within a few months. Compared to Blalock-Taussig shunt, stented duct result in
similar but more uniform pulmonary artery growth over a mid-term follow-up.
In conclusion, arterial duct stenting is a technically feasible, safe and effective palliation
in congenital heart disease with duct-dependent pulmonary circulation. It is advisable
either in high-risk neonates or whenever a short-term pulmonary blood flow support is
anticipated. The stented duct appears less durable than a conventional surgical shunt
although it is highly effective in promoting a global and uniform pulmonary artery
growth.
Keywords: Congenital heart disease, duct-dependent pulmonary circulation,
patent ductus arteriosus, arterial duct stenting, tetralogy of Fallot, systemic-topulmonary
shunt, pulmonary artery discontinuity, pulmonary artery growth,
pulmonary atresia, Ebstein anomaly.
