PMC3915966_01
Proximal ductus arteriosus stenosis after the hybrid stage I procedure in a newborn with hypoplastic left heart syndrome. A - Echocardiography - restrictive blood flow through ductus arteriosus. B - Ventriculography - proximal stenosis of unstented part of the ductus (arrow)
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From the 7th day after the procedure ECHO studies showed progressive deterioration of the right ventricular function with increasing tricuspid regurgitation and symptoms of stenosis in the proximal part of the PDA, which was confirmed by the diagnostic catheterization (Figure 1).
Cardiac catheterization - lateral view. A - Second stent implantation into ductus arteriosus. B - Post-intervention view
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For that reason a second stent was immediately implanted to the stenosed proximal PDA segment using a telescopic technique (Figure 2).
Control echocardiographic examination after second stent into ductus arteriosus implantation - nonrestrictive blood flow from pulmonary artery into aorta
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Free flow from the pulmonary artery to the aorta was achieved (Figure 3).
Phlebography - status after HLHS comprehensive hybrid stage II. Antero-posterior view; contrast infusion through vena subclavia sinistra; opacification of both pulmonary arteries through Glenn anastomosis
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A second stage of treatment was performed in the 5th month of the child's life (HLHS comprehensive hybrid stage II, Figure 4).