Transcript martinez
DUCTAL STENTING THROUGH LEFT INTERNAL CAROTID ARTERY IN A 5 YEAR OLD MALE WITH PULMONARY VALVE ATRESIA: A CASE REPORT Bee Jane T. Martinez, MD UP-PGH Department of Pediatrics Section of Cardiology To discuss - ductal stenting and its technique - ductal stenting compared to mBTS - different vascular access GENERAL DATA: KB, 5/M Tetralogy of Fallot with Pulmonary Valve Atresia with a restrictive vertical PDA supplying the pulmonary arteries - cyanosis at birth - 6 to 10 months - saturations 52% at room air - mBTS ductal stenting PHYSICAL EXAMINATION: • dusky lips, RV heave, loud and single S2 with no murmur, cyanotic and clubbed nail beds. • cyanotic and clubbed nail beds DIAGNOSTICS • 2D-echocardiography showed Tetralogy of Fallot (TOF) with Pulmonary valve atresia (PVA). The pulmonary arteries were small and confluent and were supplied by vertical ductus DIAGNOSTICS • Angiogram showed vertical ductus supplying small confluent PAs not accessible for pda stenting from the femoral arteries Subclavain Artery Internal Carotid Artery • Over the past three decades, the technique of ductal stenting has markedly improved along side developments in catheter and stent technology • Ductal stenting has been almost exclusively done in newborn infants as a short-term palliation. Xu W, Xia C, Zhang Z, et al. Efficacy of arterial duct stenting in neonatal pulmonary atresia with intact ventricular septum. Jul 2011; 39(7): 621-624. • Vascular access • Femoral artery, femoral vein, right axillary or left axillary artery …. Alwi M. Stenting the ductus arteriosus: Case selection, technique and possible complications. Ann Pediatr Cardiol. Jan-Jun 2008; • Right carotid arteriotomy …used in low 1(1): 38–45 birth weight neonates… Schneider M, Zartner, Sidiropoulos P, et al. Stent implantation of the arterialleft duct in newborns with duct-dependent circulation. • In our patient, the carotid European Heart Journal. 1998;19: 1401–1409 arteriotomy • Post ductal stenting, the saturations at room air increased from a baseline of 52% to 85% • Post ductal stenting, there was an LPA improvement in the degree of blood flow RPA toward both PAs. • The child had a rapid recovery and was discharged 24 hours after the procedure. PDA STENTING mBTS P40, 000 P120,000170,000 P40,000 P200,000 2 days 5-7 days Bleeding, stent occlusion Scarring, adhesions, bleeding, shunt occlusion, phrenic nerve injury, Cost Charity Pay Duration of hospital stay Complications • ductal stenting in older children, like those in neonates, can also be safely and effectively performed as an alternative to mBTS • unique technique with low complication rates • hospital stay of the patient was shorter in ductal stenting compared with mBTS THANK YOU