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

Background 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 quantitative 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. Methods This retrospective, single-center study included patients who underwent PDA stenting or modified Blalock-Taussig-Thomas from January 2010 to March 2025. Pre-procedural 3D reconstruction was performed for a subset of patients, allowing for detailed analysis of ductal tortuosity, vessel diameter, and other anatomic variables. Procedural outcomes, including radiation exposure, procedure time, and the need for reintervention, were compared between the 3D and non-3D-guided groups. Results A total of 46 patients were included in the analysis, with 26 having preprocedural 3D-guided planning. The 3D group demonstrated significantly lower mean Air Kerma (50.4 vs 108 mGy, p = 0.0149) and dose area product (186 vs 344 cGy·cm², p = 0.0295). Case length and fluoroscopy time were shorter but not statistically significant. There was a trend toward fewer reinterventions in the 3D group (10% vs 18%, p = 0.06). Stratification by tortuosity type revealed that 3D planning was particularly beneficial in cases with high tortuosity. Conclusion 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.