A non-syndromic male infant, born at 34 weeks of gestation with a birthweight of 1,500 g, was diagnosed with common arterial trunk with a left-sided interrupted aortic arch distal to the left subclavian artery, corresponding to the anatomy historically described as van Praagh type A4 (Figure 1a–c). ^{Reference Liu, Chen and Zühlke1,Reference Russell, Jacobs and Anderson2} Given the high mortality risk associated with open-heart surgery in the context of prematurity and very low birthweight, multidisciplinary team discussion favoured hybrid palliation as a bridge to later, lower-risk repair. Using a CT-based three-dimensional virtual model (Figure 1c, Supplementary-Video-1), transaortic ductal stenting was performed through a mini-sternotomy: the ascending aorta was punctured using a 20-gauge needle, and a 4-French sheath was inserted under intravenous heparin infusion (Figure 2a). A 0.014-inch guidewire was advanced across the arterial duct, and a 5.0×12 mm pre-mounted drug-eluting coronary stent (Synergy Megatron, Boston Scientific) was deployed at 16 atmospheres and post-dilated to a diameter of 5.5 mm (Figure 2b, c). The sheath was removed, the purse-string suture closed, and bilateral pulmonary artery banding performed. Angiography and echocardiography confirmed complete ductal coverage, unrestricted systemic blood flow, and restricted pulmonary blood flow (4 m/s across both pulmonary artery bands) (Figure 2d). The postoperative course was uneventful under dual antiplatelet therapy, and a Rastelli-type repair with aortic arch reconstruction was successfully performed five months later.

Figure 1.

Computed tomography. Common arterial trunk with pulmonary dominance (a–c: star), interrupted aortic arch (b,c: arrow), and duct-dependent systemic circulation (b,c: dotted arrow).

Figure 2.

Hybrid palliation. Transaortic puncture (a: star), contrast injection delineating the arterial duct (b) and ductal stenting (c: arrow), and postprocedural echography showing unrestricted systemic blood flow and restricted pulmonary blood flow (d: dotted arrow).

Common arterial trunk and interrupted aortic arch individually account for 0.98% (0.078/1000 live births) and 0.61% (0.041/1000 live births) of CHDs, respectively. ^{Reference Liu, Chen and Zühlke1} Their association is rare, reported in 12% of cases of common arterial trunk. ^{Reference Gikandi, Brown and Bhave3} Although single-stage neonatal repair can be performed safely in term infants, ^{Reference Russell, Jacobs and Anderson2} prematurity, low birthweight, and additional cardiac defects remain major risk factors for in-hospital mortality, ^{Reference Konstantinov, Karamlou and Blackstone4,Reference Forestieri, Olshan and Oster5} prompting increasing use of risk-stratified, staged strategies incorporating bilateral pulmonary artery banding in high-risk neonates with common arterial trunk. Hybrid palliation combining ductal stenting with bilateral pulmonary artery banding has been reported in high-risk interrupted aortic arch, including low-birthweight or premature infants, ^{Reference Karimi, Farouk, Golden and Gilkeson6,Reference Romans, Armstrong and Aiyagari7} and Sakata et al. described isolated ductal stenting, without banding, in a neonate with common arterial trunk and interrupted aortic arch. ^{Reference Sakata, Hayabuchi, Inoue and Kagami8} To our knowledge, the only prior report applying the combined hybrid concept—ductal stenting together with bilateral pulmonary artery banding—specifically to the common arterial trunk with interrupted aortic arch described two neonates managed in a resource-limited setting. ^{Reference Mohsin, Ahmed, Karim and Sadqani9} The present case differs from all of these reports in four respects: the combination, within a single procedure, of off-pump transaortic ductal stenting through a mini-sternotomy with bilateral pulmonary artery banding; its application in an extremely premature, very low-birth-weight infant with common arterial trunk, pulmonary dominance, and duct-dependent systemic circulation; planning of the procedure using patient-specific three-dimensional virtual modelling; and its completion with successful surgical repair. This combination, rather than the broader use of hybrid palliation alone, defines the distinctive contribution of the present report. ^{Reference Russell, Jacobs and Anderson2,Reference Karimi, Farouk, Golden and Gilkeson6–Reference Kobayashi, Sano and Narumiya10}