Evaluation of the Growth of Central Pulmonary Arteries Following Patent Ductus Arteriosus Stenting in Patients with Duct Dependent Pulmonary Circulation

Pulmonary arteries' (PAs) growth can be promoted by stenting of patent ductus arteriosus (PDA). This may result in better angle between the PDA and the PAs, allowing improved growth. In this study, we sought to evaluate the effect of PDA stenting on the growth of the pulmonary arteries by comparing their dimensions pre-stenting to their dimensions in the pre-second stage operations in patients with congenital heart diseases-duct-dependent pulmonary (CHD-DDP) circulation. Between January 2015 and December 2016, 58 neonates with CHD-DDP circulation underwent transcatheter PDA stenting and had evaluation of PAs growth before the second stage. Various parameters [Pre-branching right and left pulmonary artery (RPA, LPA) diameters, their Z scores, LPA/RPA ratio, McGoon's ratio and Nakata index] were recorded and compared pre-stenting and pre-second stage. The evaluation was done using catheterization or multislice computed tomography (MSCT). PDA stenting was successful in 49 patients out of 58 (84.5%) patients with an age of 13.5 +/- 10.4 days and a weight of 2.9 +/- 0.5 kg. Twenty-two (44.9%) patients had complex CHD-DDP, 14 (28.6%) patients had PA/IVS and 13 (26.5%) patients had PA/VSD. Pre-second stage RPA, LPA diameters and their Z scores increased significantly (RPA increased from 0.36 +/- 0.05 cm to 0.60 +/- 0.11 cm,P < 0.001, RPA Z-score increased from - 1.29 +/- 0.91 to 0.81 +/- 0.18,P < 0.001; LPA increased from 0.34 +/- 0.06 cm to 0.58 +/- 0.10 cm,P < 0.001, LPA Z-score increased from - 1.17 +/- 0.86 to 0.97 +/- 0.48,P < 0.001). McGoon's ratio increased significantly from 1.20 +/- 0.11 to 1.61 +/- 0.15 (P < 0.001). Nakata index increased from 105.94 +/- 33.53 to 183.48 +/- 40.58 mm(2)/m(2)(P < 0.001). However, LPA/RPA ratio did not change (0.96 +/- 0.05 and 0.98 +/- 0.16,P = 0.288). PDA stenting is effective in promoting the global and the individual pulmonary artery growth in congenital heart diseases with duct-dependent pulmonary circulation. In this study, we presented our experience with this approach in 2 tertiary care centers in the DELTA region of Egypt. PDA stenting, generally, showed symmetric growth of the pulmonary arteries with comparable results to the international figures.