日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Background: The Blalock-Taussig shunt (BTS) is the standard first-stage surgical palliative treatment for congenital heart disease with duct-dependent pulmonary circulation (CHD-DPC). Although ductal-stenting (DS) is rarely performed, it is feasible and safe for patients with a high perioperative risk.

Method: We retrospectively investigated four patients who underwent DS for CHD-DPC at our hospital. The data of patients who underwent DS and BTS (n＝76) for CHD-DPC were analyzed. Then, an intergroup comparison of perioperative complications and mortality rates was performed.

Results: All patients successfully underwent DS. After DS, two patients required medical treatment for heart failure secondary to increased pulmonary perfusion. After 1 month, re-in-stenting was performed due to in-stent restenosis. One patient developed total occlusion at the approach site of the right femoral artery (FA). Therefore, balloon-expandable stents were deployed into the FA. With regard to prognosis, one patient underwent the bidirectional Glenn procedure and was waiting to undergo the Fontan procedure. Moreover, two patients underwent the Rastelli procedure. One patient with trisomy 18 was discharged. The perioperative complication and mortality rates were higher in patients who underwent BTS with extra-cardiac anomaly or chromosomal abnormalities than in those who underwent DS.

Conclusion: DS is an effective first-stage palliative strategy for patients with a high perioperative risk. Moreover, DS can be further improved by optimizing the stent size and approach site.