1. DUCTAL STENTING THROUGH LEFT INTERNAL CAROTID ARTERY IN A 5 YEAR OLD MALE WITH PULMONARY VALVE ATRESIA: A CASE REPORT Bee Jane T. Martinez, MD UP-PGH Department of Pediatrics Section of Cardiology

2. To discuss -ductal stenting and its technique -ductal stenting compared to mBTS -different vascular access

3. GENERAL DATA: KB, 5/M Tetralogy of Fallot with Pulmonary Valve Atresia with a restrictive vertical PDA supplying the pulmonary arteries

4. - cyanosis at birth - 6 to 10 months - saturations  52% at room air - mBTS  ductal stenting

5. PHYSICAL EXAMINATION: dusky lips, RV heave, loud and single S2 with no murmur, cyanotic and clubbed nail beds. cyanotic and clubbed nail beds

6. DIAGNOSTICS 2D-echocardiography showed Tetralogy of Fallot (TOF) with Pulmonary valve atresia (PVA). The pulmonary arteries were small and confluent and were supplied by vertical ductus

7. DIAGNOSTICS Angiogram showed vertical ductus supplying small confluent PAs not accessible for pda stenting from the femoral arteries

9. Internal Carotid Artery Subclavain Artery

13. Over the past three decades, the technique of ductal stenting has markedly improved along side developments in catheter and stent technology Ductal stenting has been almost exclusively done in newborn infants as a short-term palliation. Xu W, Xia C, Zhang Z, et al. Efficacy of arterial duct stenting in neonatal pulmonary atresia with intact ventricular septum. Jul 2011; 39(7): 621-624.

14. Vascular access Femoral artery, femoral vein, right axillary or left axillary artery …. Right carotid arteriotomy …used in low birth weight neonates… In our patient, the left carotid arteriotomy Alwi M. Stenting the ductus arteriosus: Case selection, technique and possible complications. Ann Pediatr Cardiol. Jan-Jun 2008; 1(1): 38–45 Schneider M, Zartner, Sidiropoulos P, et al. Stent implantation of the arterial duct in newborns with duct-dependent circulation. European Heart Journal. 1998;19: 1401–1409

15. Post ductal stenting, the saturations at room air increased from a baseline of 52% to 85% Post ductal stenting, there was an improvement in the degree of blood flow toward both PAs. The child had a rapid recovery and was discharged 24 hours after the procedure. LPA RPA

16. PDA STENTINGmBTS Cost Charity Pay P40, 000 P120,000- 170,000 P40,000 P200,000 Duration of hospital stay 2 days5-7 days ComplicationsBleeding, stent occlusion Scarring, adhesions, bleeding, shunt occlusion, phrenic nerve injury,

17. ductal stenting in older children, like those in neonates, can also be safely and effectively performed as an alternative to mBTS unique technique with low complication rates hospital stay of the patient was shorter in ductal stenting compared with mBTS

19. THANK YOU