ductal stenting through left internal carotid artery in a 5 year old male with pulmonary valve...
TRANSCRIPT
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DUCTAL STENTING THROUGH LEFT INTERNAL CAROTID ARTERY IN A 5
YEAR OLD MALE WITH PULMONARY VALVE ATRESIA: A CASE REPORT
Bee Jane T. Martinez, MDUP-PGH Department of Pediatrics
Section of Cardiology
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To discuss-ductal stenting and its technique-ductal stenting compared to mBTS-different vascular access
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GENERAL DATA:KB, 5/M
Tetralogy of Fallot with Pulmonary Valve Atresia with a restrictive vertical PDA supplying the pulmonary arteries
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- cyanosis at birth
- 6 to 10 months
- saturations 52% at room air
- mBTS ductal stenting
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PHYSICAL EXAMINATION: •dusky lips, RV heave, loud and single S2 with no murmur, cyanotic and clubbed nail beds. •cyanotic and clubbed nail beds
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DIAGNOSTICSDIAGNOSTICS• 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
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DIAGNOSTICSDIAGNOSTICS•Angiogram showed vertical ductus supplying small
confluent PAs not accessible for pda stenting from
the femoral arteries
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Internal Carotid Artery
Subclavain Artery
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• 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.
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• Vascular access • Femoral artery, femoral vein, right
axillary or left axillary artery …. • Right carotid arteriotomy …used in low
birth weight neonates…• In our patient, the left carotid
arteriotomy
Alwi M. Stenting the ductus arteriosus: Case selection, technique and possible complications. Ann Pediatr Cardiol. Jan-Jun 2008;
1(1): 38–45
Schneider M, Zartner, Sidiropoulos P, et al. Stent implantation of the arterial duct in newborns with duct-dependent circulation. European Heart Journal. 1998;19: 1401–1409
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• Post ductal stenting, the saturations at room air increased from a baseline of 52% to 85%
• Post ductal stenting, there was an improvement in the degree of blood flow toward both PAs.
• The child had a rapid recovery and was discharged 24 hours after the procedure.
LPA
RPA
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PDA STENTING mBTS
Cost Charity Pay
P40, 000P120,000-170,000
P40,000P200,000
Duration of hospital stay
2 days 5-7 days
Complications Bleeding, stent occlusion
Scarring, adhesions,
bleeding, shunt occlusion,
phrenic nerve injury,
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• 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
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THANK YOU