PDA Stenting for Ductal-Dependent Cyanotic Congenital Heart Disease: History and View from 10,000 Feet

This article provides a historical review and a current perspective on the procedures used to palliate cyanosis in ductal-dependent infants. Eighty years ago, Helen Taussig, Alfred Blalock, and Vivien Thomas developed the first effective treatment. The Blalock-Taussig-Thomas (BTT) shunt is the historical predecessor of both the contemporary-modified BTT shunt and interventional stenting of the Patent Ductus Arteriosus (PDA). The surgical shunt was firmly established therapy before catheterization was born, and PDA stenting was not possible until the technologies designed to address coronary heart disease were developed. Coronary stents and guidewires are currently used in all cases of PDA stenting. The momentum of long-established therapy and the lack of a purpose-built technology have inhibited clinical adoption of PDA stenting. Nevertheless, available clinical outcomes, though limited, appear to favor PDA stenting, and current first-line therapy may be shifting from the modified BTT shunt to PDA stenting. More definitive data should arise from a randomized controlled trial.