53. Bilateral ductal stenting for nonconfluent pulmonary arteries in a newborn

Bilateral PDA dependent pulmonary circulation with right and left pulmonary artery discontinuity is very rare. Limited data available for bilateral PDA stenting. Bilateral PDA stenting in nonconfluent pulmonary arteries is challenging procedure but can be considered as an option in the management of complex conditions like this. 12 days old Preterm (36 weeks gestation) male baby with birth weight of 2.6 kg developed respiratory distress with severe cyanosis and desaturation upto 50%. Baby was intubated and started on Prostaglandin 0.05 mic/kg/mt. His saturation improved to 80%. Echocardiogram showed complex cyanotic heart disease, Situs ambiguous, dextrocardia, complete unbalanced AV septal defect, pulmonary atresia , nonconfluent small branch pulmonary arteries supplied by the bilateral patent ductus arteriosus (PDA) from right aortic arch and all four pulmonary veins form a confluence and drain into superior vena cava(SVC )through vertical vein with no obstruction. Baby was taken up for PDA stenting. descending aortogram showed right aortic arch with vertical tortuous duct to right pulmonary artery (RPA) and another short duct with acute angle from left subclavian artery to left pulmonary artery (LPA ). Both ducti stented with coronary stents. Vertical vein angiogram showed both lungs drain to a confluence and then to SVC via ascending vertical vein with no obstruction. After stenting lung perfusion improved and the baby was stable and maintained 80% saturation on room air. Bilateral PDA dependent pulmonary circulation with right and left pulmonary artery discontinuity is very rare. Our case is unique with Heterotaxy, TAPVC, Dextrocardia and double ducti. Eventhough bilateral ductal stenting is technically challenging it is successful through femoral artery approach

54. Radiofrequency perforation of pulmonary valve and PDA stenting in a preterm neonate

Transcatheter radiofrequency perforation of the pulmonary valve and PDA stenting is considered as a modality for pulmonary atresia and intact ventricular septum with mildly hypoplastic tripartate right ventricle. We present a preterm neonate who has undergone this procedure. we assume that transcatheter radiofrequency perforation of pulmonary valve and PDA stenting is a safer approach for pulmonary atresia with intact ventricular septum in preterm newborns, than surgical approach.We present 5 days old, preterm (36 weeks gestation) baby girl, with 2.2 kg. She was reffered to our centre with the diagnosis of pulmonary atresia with intact ventricular septum, mildly hypoplastic tripartate right ventricle. Right ventricle angiography showed tripartate right ventricle with no sinusoids. She underwent successful radiofrequency perforation of pulmonary valve followed by balloon dilatation. At the same time prograde PDA stenting was done. Repeat right ventricle angiography showed good right ventricular outflow tract forward flow, and descending aorta angiography showed good PDA flow supplying both pulmonary arteries. The baby was extubated on same day, and prosoglandin E1 was discontinued immediately after the procedure.The baby mainatined saturation more than 80% on room air. The baby was discharged after 2 days. Our case is pecular because to our knowledge this is the lowest weight for wich radiofrequency perforation and PDA stenting is done as well as being preterm