Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation.
<h4>Objectives</h4>Percutaneous patent ductus arteriosus (PDA) stenting is a therapeutic modality in patients with duct-dependent pulmonary circulation with reported success rates from 80-100%. The current study aims to assess the outcome and the indicators of success for PDA stenting in...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0265031 |
| _version_ | 1828746322005458944 |
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| author | Hala Mounir Agha Osama Abd-El Aziz Ola Kamel Sahar S Sheta Amal El-Sisi Sonia El-Saiedi Aya Fatouh Amira Esmat Gaser Abdelmohsen Baher Hanna Mai Hussien Rodina Sobhy |
| author_facet | Hala Mounir Agha Osama Abd-El Aziz Ola Kamel Sahar S Sheta Amal El-Sisi Sonia El-Saiedi Aya Fatouh Amira Esmat Gaser Abdelmohsen Baher Hanna Mai Hussien Rodina Sobhy |
| author_sort | Hala Mounir Agha |
| collection | DOAJ |
| description | <h4>Objectives</h4>Percutaneous patent ductus arteriosus (PDA) stenting is a therapeutic modality in patients with duct-dependent pulmonary circulation with reported success rates from 80-100%. The current study aims to assess the outcome and the indicators of success for PDA stenting in different ductal morphologies using various approaches.<h4>Methods</h4>A prospective cohort study from a single tertiary center presented from January 2018 to December 2019 that included 96 consecutive infants with ductal-dependent pulmonary circulation and palliated with PDA stenting. Patients were divided according to PDA origin into 4 groups: Group 1: PDA from proximal descending aorta, Group 2: from undersurface of aortic arch, Group 3: opposite the subclavian artery, Group 4: opposite the innominate/brachiocephalic artery.<h4>Results</h4>The median age of patients was 22 days and median weight was 3 kg. The procedure was successful in 78 patients (81.25%). PDA was tortuous in 70 out of 96 patients. Femoral artery was the preferred approach in Group 1 (63/67), while axillary artery access was preferred in the other groups (6/11 in Group 2, 11/17 in Group 3, 1/1 in Group 4, P <0.0001). The main cause of procedural failure was inadequate parked coronary wire inside one of the branch of pulmonary arteries (14 cases; 77.7%), while 2 cases (11.1%) were complicated by acute stent thrombosis, and another 2 cases with stent dislodgment. Other procedural complications comprised femoral artery thrombosis in 7 cases (7.2%). Patients with straight PDA, younger age at procedure and who had larger PDA at pulmonary end had higher odds for success (OR = 8.01, 2.94, 7.40, CI = 1.011-63.68, 0.960-0.99, 1.172-7.40,respectively, P = 0.048, 0.031,0.022 respectively).<h4>Conclusions</h4>The approach for PDA stenting and hence the outcome is markedly determined by the PDA origin and morphology. Patients with straight PDA, younger age at procedure and those who had relatively larger PDA at the pulmonary end had better opportunity for successful procedure. |
| first_indexed | 2024-04-14T04:23:29Z |
| format | Article |
| id | doaj.art-e4f89f9a70884cca8e44512c1f7aab04 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-14T04:23:29Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-e4f89f9a70884cca8e44512c1f7aab042022-12-22T02:12:26ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01174e026503110.1371/journal.pone.0265031Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation.Hala Mounir AghaOsama Abd-El AzizOla KamelSahar S ShetaAmal El-SisiSonia El-SaiediAya FatouhAmira EsmatGaser AbdelmohsenBaher HannaMai HussienRodina Sobhy<h4>Objectives</h4>Percutaneous patent ductus arteriosus (PDA) stenting is a therapeutic modality in patients with duct-dependent pulmonary circulation with reported success rates from 80-100%. The current study aims to assess the outcome and the indicators of success for PDA stenting in different ductal morphologies using various approaches.<h4>Methods</h4>A prospective cohort study from a single tertiary center presented from January 2018 to December 2019 that included 96 consecutive infants with ductal-dependent pulmonary circulation and palliated with PDA stenting. Patients were divided according to PDA origin into 4 groups: Group 1: PDA from proximal descending aorta, Group 2: from undersurface of aortic arch, Group 3: opposite the subclavian artery, Group 4: opposite the innominate/brachiocephalic artery.<h4>Results</h4>The median age of patients was 22 days and median weight was 3 kg. The procedure was successful in 78 patients (81.25%). PDA was tortuous in 70 out of 96 patients. Femoral artery was the preferred approach in Group 1 (63/67), while axillary artery access was preferred in the other groups (6/11 in Group 2, 11/17 in Group 3, 1/1 in Group 4, P <0.0001). The main cause of procedural failure was inadequate parked coronary wire inside one of the branch of pulmonary arteries (14 cases; 77.7%), while 2 cases (11.1%) were complicated by acute stent thrombosis, and another 2 cases with stent dislodgment. Other procedural complications comprised femoral artery thrombosis in 7 cases (7.2%). Patients with straight PDA, younger age at procedure and who had larger PDA at pulmonary end had higher odds for success (OR = 8.01, 2.94, 7.40, CI = 1.011-63.68, 0.960-0.99, 1.172-7.40,respectively, P = 0.048, 0.031,0.022 respectively).<h4>Conclusions</h4>The approach for PDA stenting and hence the outcome is markedly determined by the PDA origin and morphology. Patients with straight PDA, younger age at procedure and those who had relatively larger PDA at the pulmonary end had better opportunity for successful procedure.https://doi.org/10.1371/journal.pone.0265031 |
| spellingShingle | Hala Mounir Agha Osama Abd-El Aziz Ola Kamel Sahar S Sheta Amal El-Sisi Sonia El-Saiedi Aya Fatouh Amira Esmat Gaser Abdelmohsen Baher Hanna Mai Hussien Rodina Sobhy Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. PLoS ONE |
| title | Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. |
| title_full | Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. |
| title_fullStr | Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. |
| title_full_unstemmed | Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. |
| title_short | Margin between success and failure of PDA stenting for duct-dependent pulmonary circulation. |
| title_sort | margin between success and failure of pda stenting for duct dependent pulmonary circulation |
| url | https://doi.org/10.1371/journal.pone.0265031 |
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