A Challenging Case of Hybrid PDA Stenting on a One-Day-Old Baby

Overview

One-day baby, born by caesarean section with a birth weight of 2.3 kg, was found to be  cyanosed at birth with SpO2 – 65%. The baby was referred to SRCC Children’s Hospital, managed by  Narayana Health, for cardiac evaluation. The echocardiogram at 6 hours of life confirmed a diagnosis of TETRALOGY OF FALLOT  WITH PULMONARY ATRESIA.

This is duct-dependent pulmonary circulation, and the treatment needs to start within the first few days of life, before the  PDA closes spontaneously.

She was admitted to the NICU and began on PGE1 infusion to maintain ductal patency. On day 4 of life, she was taken to the cath lab for ductal stenting, and the procedure was done with a  unique hybrid carotid approach, where the carotid artery was accessed with an open carotid cut down by the cardiac surgeons, and then the interventional pediatric cardiologists proceeded to deploy a stent in the PDA to allow the PDA to remain patent for the next 6-12  months.

During the complete repair,  the VSD was closed, and an  RV to PA conduit was used

to connect the right ventricle to the pulmonary arteries. She was observed in the cardiac ICU for 72 hours and was discharged home eight days after the procedure. The child was on regular follow-ups with us since then and returned for the definitive surgical repair of Tetralogy with Pulmonary atresia at 9 months of age. The child is now 2 years old and doing well with normal activity and development.

Hybrid PDA Stenting

HYBRID PDA STENTING is the standard first palliation in pulmonary atresia patients, who do not have a main pulmonary artery connecting the right ventricle to the branch pulmonary arteries. PDA stenting is physiologically similar to modified BT shunts, but is preferred at most cardiac centres as the patient’s condition and post-op course are more stable after stenting. In this procedure, we place a coronary stent across the PDA, and these patients are then discharged on dual antiplatelet therapy. The patients return for their complete surgical correction 6-12 months later.

The Bi-Plane Cath Lab at the institute allows us to perform such complex procedures with greater precision and safety.

 

Dr. Supratim Sen	Paediatric Cardiologist	Interventional Paediatric Cardiology, Complex Cardiac	Transplantation Over 10,000 children with heart defects seen
Dr. Pradeep Kaushik	Paediatric Cardiac Surgeon	Complex Congenital Heart Surgery, Paediatric Heart	Over 20,000 children with heart defects seen in OPD -Over 5,000 children underwent heart surgeries/procedures

 

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