PDA Stenting with Versus Without Pre-Procedural 3D Reconstruction: Impact on Radiation Exposure and Procedural Outcomes

Managing patients with patent ductus arteriosus (PDA) and complex anatomical features, such as tortuosity and branching anomalies, remains a challenge in interventional cardiology. Recent advances in three-dimensional (3D) reconstruction and morphologic analysis of ductal anatomy have shown promise in improving procedural outcomes. This study evaluates the utility of 3D reconstruction in pre-procedural planning for PDA stenting. This retrospective, single-center study included patients who underwent PDA stenting from June 2018 to March 2025. Pre-procedural CT and 3D reconstructions were performed for a subset of patients, allowing for detailed analysis of ductal tortuosity. Procedural outcomes, including radiation exposure/dose, procedure time, and the need for reintervention were compared between the 3D- and non-3D-guided groups. A total of 46 patients were included in the analysis, with 27 having preprocedural 3D-guided planning. The 3D group demonstrated significantly lower mean effective radiation dose (77 vs. 114 mSv, p = 0.0331). Case length and fluoroscopy time were shorter but not statistically significant. The need for catheter-based reintervention tended to be lower in the 3D group (10% vs. 18%, p = 0.06), but the difference did not reach statistical significance. Stratification by tortuosity type regardless of 3D implementation did not have statistically significant correlation to patient outcomes. Preprocedural 3D reconstruction is a valuable tool in planning PDA interventions with a high success rate and significantly lower radiation exposure. These findings support the incorporation of 3D modeling into routine clinical practice for complex PDA cases, potentially improving procedural efficiency and patient outcomes.