The Fate of the Jailed Branch: Challenging the Dogma of PDA Stenting in Cases with a Pulmonary Artery Branch Originating from the PDA

Patent ductus arteriosus (PDA) stenting is evolving as the preferred method for establishing stable pulmonary blood flow in cyanotic infants, offering lower mortality, faster recovery, and shorter hospital stays. However, stenting may lead to branch pulmonary artery (BPA) jailing, potentially restricting blood flow to the jailed branch. This study analyzes patient characteristics, cardiovascular anatomy, stenting techniques, and outcomes involving BPA jailing where the BPA originates from the PDA, with a focus on the growth of the jailed BPA. A retrospective review was conducted of infants with duct-dependent pulmonary blood flow who underwent PDA stenting at Rady Children's Hospital San Diego from 2013 to 2024. Of 70 infants, 22 (31%) experienced BPA jailing due to the BPA originating from the PDA. The median age and weight at stenting were 9.5 days and 3275 g, with PDA as the sole source of pulmonary blood flow in 72% of cases. PDA type III was the most prevalent (77%). The jailed BPA showed significant distal growth (mean Nakata index increase of 117.35 mm²/m², p = 0.0001), with symmetry maintained. Re-intervention for hypoxia was required in 55% of cases and involved ballooning, re-stenting, and strut dilation. There were no 30-day mortalities (2 late deaths occurred). Progression to Glenn palliation occurred in 12 patients, 5 had a definitive repair, 1 underwent left pulmonary artery plasty and a BT shunt and 2 await repair. PDA stenting in infants with a BPA originating from the PDA is feasible with notable distal BPA growth despite frequent re-interventions. Patients maintained pulmonary artery symmetry with excellent survival.