Analysis The Efficacy Of Arterial Duct Stenting In Neonatal Pulmonary Atresia With Intact Ventricular Septum

Objective:Pulmonary atresia with intact ventricular septum (PA/IVS) is a rare cyanotic congenital heart disease (CHD), with high mortality. It happens around1%in the CHD. Most of the patients are in critical condition in their early period life time. In these patents, the right ventricular have no outflow tract, so the right ventricular pressure is higher than that of the systemic circulation. The pulmonary circulation is dependent on the ductus arteriosus open. If the ductus arteriosus closure, the patients will die soon. There is no unified standard for early intervention the disease, because the high mortality after the early operation. So this is the most important issue for the pediatric cardiac surgeons to solve.We first propose the mosaic method to treatment the PA/IVS patients, which combined patent ductus stent implantation and later surgical operation This method has efficacy in the follow-up period after treatment. Methods:Eleven neonatal with PA/IVS patients received arterial duct stenting in our hospital from December2007to June2014were involved in this study. The stents were selected according to digital subtracted angiography measurements. After checking for correct position by angiography, the balloon was inflated to expand the stent to desired diameter. Oxygen saturation was momtored, echocardiography was measured and stent diameter and location were observed by chest X-ray. Patients were followed up at1,3,6months post procedure.Results:Stents were successfully implanted in all15patients. The preoperative peripheral oxygen saturation was (62.87±7.55)%, while increased to (81.27±5.36)%after alprostadil application and to (84.73±3.69)%after operation (all P<0.01). After the operation, the peripheral oxygen saturation was higher than alprostadil application (P<0.05). The intraoperative narrowest diameter of patent ductus arteriosus was (1.80±0.37) mm, the length was (16.6±2.20) mm. The internal diameter of implant stents was4mm, the length was (20.6±3.18) mm. After the operation, surgical B-T shunt operation was performed in one patient due to stent shift and pulse oxygen saturation decrease, one of them died post-surgery with unknown reason, one patient received stent balloon dilatation due to pulse oxygen saturation decrease at4months after the surgery. Pulmonary atresia with intact ventricular septum surgeries were performed in10patients at5to7months after stent implantation,3patients lost that we can’t follow up well. Conclusion:The neonatal pulmonary atresia with intact ventricular septum arterial stent implantation was an effective procedure and this procedure could reduce the risk of secondary surgery. This method could be used as preferred treatment in pulmonary atresia and intact ventricular septum for neonates.