INCREASED PULMONARY BLOOD FLOW IN NEWBORNS WITH CYANOTIC CONGENITAL HEART DEFECTS AND DUCTUS-DEPENDENT PULMONARY BLOOD FLOW: RESULTS AND FEATURES OF OUTPATIENT POSTOPERATIVE FOLLOW-UP
Authors: Mykhailovska Anzhelika , Borodinova Olga , Tammo Raad 
Published: January 2025

Aim. In patients with cyanotic congenital heart defects, pulmonary blood flow is maintained by a functioning patent ductus arteriosus (PDA). Most patients with complex duct-dependent cyanotic defects require intermediate palliative treatment before proceeding of total repair. Timely and complex outpatient monitoring by a pediatrician and pediatric cardiologist are important for patient survival following palliative treatment, along with determining optimal timing for consultations at specialized cardiac surgical centers. To present the outcomes of two methods for increasing pulmonary blood flow (systemic-to-pulmonary artery shunt (SPAS) and stenting of patent ductus arteriosus (PDA st.)), as well as the features of outpatient cardiological observation and treatment in these patients.
Materials and Methods. From 2000 to February 2024, 22 patients underwent SPAS (SPAS group), and stenting of patent ductus arteriosus was performed on 27 patients (PDA st. group) at the Ukrainian Cardiac Center.
Results and Discussion. After interventions, the mean arterial oxygen saturation (SatO2) significantly increased in both groups, with a significantly higher improvement in the PDA st. group (p<0.05). The median average period of stay in ICU for the SPAS group was 15 [10.25; 24.75] days (from 5 to 91 days), for the group of PDA st. - 10 [7; 19,25] days (from 4 to 37 days) and was shorter in the group of PDA st. (p=0.05), and the duration of mechanical ventilation in the SPAS group was 254 [39.5; 471] hours (from 63 to 751 hours), and in the group of PDA st. was shorter - 134 [92.75; 158.7] (from 39 to 549 hours) (p<0.05). Early (30-day) postoperative mortality in the SPAS group accounted 13.6% (3 patients), with a late mortality of 18% (4/22). In contrast, there was no early (30-day) postoperative mortality in the PDA st. group, and late mortality accounted for 7,4% (2/27). Before the subsequent stage of surgical correction, sufficient growth of pulmonary artery branches was noted (Nakata index increased from 156.9±33.3 mm2/m2 to 277±35.9 mm2/m2 in the SPAS group and from 142.7±55.2 mm2/m2 to 289.1±149.2 mm2/m2 in the PDA st. group, and the left ventricular end-diastolic dimension index increased from 51.2±32.4 mm2/m2 to 67.5±15.5 mm2/m2 in the SPAS group and from 50.8±24.9 mm2/m2 to 56.7±28.5 mm2/m2 in the PDA st. group. Thirteen patients in the SPAS group underwent the next stage of surgical correction (Glenn shunt or total repair), while 19 patients in the PDA st. group received the next stage of surgical correction.
Conclusions. Our study has demonstrated that both described methods are sufficiently effective for managing duct-dependent pulmonary blood flow in neonates with cyanotic CHD. Currently, due to the lower mortality rate associated with PDA stenting in neonates, it is the preferred option. However, for unfavorable ductal anatomy and in patients with CHD requiring prolonged postponement of the next surgical stage, SPAS remains more optimal choice. Careful monitoring by pediatricians and pediatric cardiologists during the interstage period is critically important.