For babies born with some types of congenital heart disease that require palliative procedures within the first few months of life, scientists are debating which procedure is the best. In a new study involving several hundred infant participants, experts from the Children’s Hospital of Philadelphia have made their decision.
The ductus arteriosus is a blood vessel that connects the aorta and the pulmonary artery during fetal blood circulation. In most healthy infants, the ductus arteriosus closes after birth. In rare cases, the ductus arteriosus must stay open to allow for stable blood flow. This can lead to a disease called patent ductus arteriosus (PDA), where oxygen-rich blood from the aorta mixes with oxygen-poor blood from the pulmonary artery, which makes the heart work harder and can increase blood pressure in the pulmonary arteries. To fix PDA, interventions must help reroute blood flow.
1. Blalock-Taussig (BT) shunt
One option is the BT shunt, the most common procedure for infants with ductal-dependent circulation, where blood is detoured to get to the pulmonary artery. This procedure was first performed in 1944 to increase pulmonary blood flow.
2. Transcatheter patent ductus arteriosus (PDA) stent
Researchers compared the BT shunt to the PDA stent, which became available in 1992 as an alternative to the BT shunt procedure. A stent is a small, wire mesh tube that opens and stabilizes an artery so blood can flow through.
In their study of 106 PDA stent procedures and 251 BT shunt procedures, researchers found that there was no difference in the mortality rate or the need for re-interventions to restore blood flow between the two procedures. However, the PDA stent still proved to be a better option for a couple of reasons:
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Fewer surgical complications
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Shorter stays in the intensive care unit (ICU)
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Less frequent need for diuretics
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Larger and more symmetric pulmonary arteries
"Our findings support PDA stents over BT shunt placement for selected patients with this condition, particularly in experienced centers where this procedure can be performed safely and effectively," explained study leader Andrew Glatz, MD, MSCE.
The present study was published in the journal Circulation.
Sources: National Heart, Lung, and Blood Disease, Radiopaedia, American Heart Association, Children’s Hospital of Philadelphia