Stent implantation in the arterial duct has achieved great acceptance as an alternative to an aortopulmonary shunt procedure. Despite challenging, also tortuous arterial ducts as in ToF and
pulmonary atresia with VSD can be addressed, since flexible open cell coronary
stents are available. We describe two patients with ToF and
Ebstein's anomaly where a special helicoid open cell
stent was implanted to cross a highly stenotic sigmoid arterial duct. In both patients, the
stent design resulted in extremely kinked
stent segments with minor or absent flow through the
stent lumen. While in one patient early ToF-repair was required, in the other recrossing and restenting with another open cell but not helicoid tubular design type of
stent allowed adequate pulmonary perfusion. Although mimicking of the natural course even in tortuous ducts is not mandatory, kinking of the
stent is likely to occur in these types of arterial ducts. On the basis of our experience, we can not recommend helicoid manufactured
stents in the scenario of ductal stenting, especially in
congenital heart disease with completely duct dependent pulmonary circulation.