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Figure 5: (A) LAO-cranial projection - ductus arteriosus in PA-IVS with severe hypoplasia of the RV. Proximal origin of ductus (opposite the origin of the left subclavian artery), but transvenous route is not feasible as there is no RV-PA continuity. (B) The tip of a cut pigtail is engaged in the ductal ampulla. A soft 0.014 guidewire (BMW) is first used to cross the ductus (small arrow), allowing some straightening of the ductal course. A stiffer wire, Choice PT extra support (big arrow) is then passed across for better tracking of balloon-stent. (C) Balloon-stent positioned along ductal length ready for expansion, softer BMW wire removed. (D) Fully expanded stent

Figure 5: (A) LAO-cranial projection - ductus arteriosus in PA-IVS with severe hypoplasia of the RV. Proximal origin of ductus (opposite the origin of the left subclavian artery), but transvenous route is not feasible as there is no RV-PA continuity. (B) The tip of a cut pigtail is engaged in the ductal ampulla. A soft 0.014 guidewire (BMW) is first used to cross the ductus (small arrow), allowing some straightening of the ductal course. A stiffer wire, Choice PT extra support (big arrow) is then passed across for better tracking of balloon-stent. (C) Balloon-stent positioned along ductal length ready for expansion, softer BMW wire removed. (D) Fully expanded stent