Patent Ductus Arteriosus Recanalization in Tricuspid Atresia with Restrictive Ventricular Septal Defect and Moderate Pulmonary Valve Stenosis: A Minimally Invasive Strategy in a Critical Case

Abstract

Background : Tricuspid Atresia (TA) is a severe cyanotic Congenital Heart Disease (CHD) characterized by the absence of the tricuspid valve, resulting in Right Ventricular (RV) hypoplasia and dependence on interatrial and extracardiac shunts for pulmonary blood flow. In cases of restrictive Ventricular Septal Defect (VSD) with pulmonary outflow tract obstruction, the pulmonary circulation becomes duct-dependent. Closure of the Patent Ductus Arteriosus (PDA) may therefore lead to life-threatening hypoxemia. Prostaglandin E1 (PGE1) infusion is commonly used to maintain ductal patency; however, in emergency situations where PGE1 is unavailable or ineffective, catheter-based PDA recanalization can serve as a minimally invasive rescue strategy. Case Illustration : A 4-month-old female with known TA presented with progressive cyanosis and respiratory distress. Echocardiography demonstrated TA, hypoplastic RV, large Atrial Septal Defect (ASD), restrictive VSD, and a ductal tunnel without detectable flow. After initial stabilization, the patient developed recurrent severe desaturation below 70% despite maximal medical and ventilatory support. Urgent cardiac catheterization revealed a functionally closed PDA. Recanalization was successfully performed using balloon dilatation followed by implantation of a 4.0 × 20 mm drug-eluting stent, restoring pulmonary blood flow and improving oxygen saturation from 55% to 91%. Conclusion : PDA recanalization with stent implantation is a viable and life-saving minimally invasive option in critically ill patients with duct-dependent CHD when pharmacologic support fails and may serve as a bridge to staged surgical palliation.