This week's topic is ductal stenting in a low resource environment. We review a recent report from the team at Amrita Institute in Kerala, India about their large, over 10 year experience in ductal stenting. Why has this approach superceded BTTS in this environment? How does the team determine if a patient is a candidate and what morphologies of duct would be inappropriate for intervention? How does the team manage PGE prior to ductal stenting to allow that perfect balance between pulmonary blood flow and ductal constriction to improve procedural success? What can operators in the west learn from the experience of these operators? We review these questions and more with the first author of this work, Dr. Navaneetha Sasikumar who is Associate Professor of Pediatrics at the Amrita Institute. DOI: 10.1007/s00246-024-03496-8