Classification scheme for ductal morphology in cyanotic patients with ductal dependent pulmonary blood flow and association with outcomes of patent ductus arteriosus stenting

• Published in: Catheterization and cardiovascular interventions Vol. 93; no. 5; pp. 933 - 943
• Main Authors: Qureshi, Athar M., Goldstein, Bryan H., Glatz, Andrew C., Agrawal, Hitesh, Aggarwal, Varun, Ligon, R. Allen, McCracken, Courtney, McDonnell, Alicia, Buckey, Timothy M., Whiteside, Wendy, Metcalf, Christina M., Petit, Christopher J.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.04.2019; Wiley Subscription Services, Inc
• Subjects: Blood flow; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Catheterization; Catheters; Classification; classification scheme; Classification schemes; Congenital diseases; congenital heart disease; Coronary Angiography; Coronary vessels; Cyanosis - etiology; cyanotic; ductal dependent pulmonary blood flow; Ductus Arteriosus - diagnostic imaging; Ductus Arteriosus - physiopathology; Ductus Arteriosus, Patent - complications; Ductus Arteriosus, Patent - diagnostic imaging; Ductus Arteriosus, Patent - physiopathology; Ductus Arteriosus, Patent - therapy; Female; Humans; Implants; Infant; Infant, Newborn; Male; Morphology; patent ductus arteriosus; Predictive Value of Tests; Pulmonary arteries; Pulmonary artery; Pulmonary Circulation; Retrospective Studies; stent; Stents; Time Factors; Tortuosity; Treatment Outcome; United States; United States; stent; classification scheme; morphology; ductal dependent pulmonary blood flow; congenital heart disease; patent ductus arteriosus; cyanotic
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28125

Objectives To devise a classification scheme for ductal morphology in patients with ductal dependent pulmonary blood flow (PBF) that can be used to assess outcomes. Background The impact of ductal morphology on outcomes following patent ductus arteriosus (PDA) stenting is not well defined. Methods Patients <1 year of age who underwent PDA stenting for ductal dependent PBF at the four centers comprising the Congenital Catheterization Research Collaborative (CCRC) were included. A classification scheme for PDA morphology was devised based on a tortuosity index (TI)—Type I (straight), Type II (one turn), and Type III (multiple turns). A subtype classification was used based upon the ductal origin. Results One hundred and five patients underwent PDA stenting. TI was Type I in 58, Type II in 24, and Type III in 23 PDAs, respectively. There was a significant association between ductal origin and vascular access site (p < 0.001). Procedure times and need for >1 stent did not differ based on TI. Greater TI was associated with pulmonary artery (PA) jailing (p = 0.003). Twelve (11.4%) patients underwent unplanned reintervention, more commonly with greater TI (p = 0.022) and PA jailing (p < 0.001). At the time of subsequent surgical repair/palliative staging, PA arterioplasty was performed in 32 patients, more commonly when a PA was jailed (p = 0.048). PA jailing did not affect PA size at follow up. Conclusions The proposed qualitative and quantitative PDA morphology classification scheme may be helpful in anticipating outcomes in patients with ductal dependent PBF undergoing PDA stenting.