Emergency PDA Stenting in a Neonate with Tricuspid and Pulmonary Atresia

Duct dependent circulation in a newborn baby presents as a life ?threatening emergency. Their circulation is maintained through flow in patent ductus arteriosus (PDA). These patients can survive only if duct patency is reliably maintained for sometime before they can be taken up for staged cardiac surgical repair. Here, we report a case of an 8 days old male baby with history of profound cyanosis and acidosis along with sepsis. On auscultation, grade - III systolic murmur was heard. Radiological investigations revealed Tricuspid and pulmonary atresia and tiny closing duct at pulmonary artery end. Practically, Duct dependent pulmonary circulation physiology. To prevent closure of the duct, prostaglandin infusion was started, inotropes, IV antibiotics started Ductal stenting was planned as surgical shunt would have associated with much higher risk. The patient showed good surgical outcome. The patient later developed 2 episodes of convulsions with CSF showing bacterial meningitis picture. The patient was treated with antiepileptics and antibiotics. The patient was successfully discharged and showed good improvement on one month of follow up. It is reasonable to assume that PDA stenting is a growing noninvasive approach for initial palliation of ductal dependent pulmonary circulation with acceptable outcome and smoother post procedure care.