Background-The technical aspects of ductal stenting have been reported, but little is known of the fate of the duct after stent implantation. Methods and Results-Nineteen patients underwent stent implantation to maintain ductal patency. Eight had hypoplastic left heart (HLH) syndrome, 10 had pulmonary atresia, and 1 had tricuspid atresia. Median survival with HLH was 57 (12 to 907) days. Stent implantation was successful in all cases of HLH, but there were no long-term survivors. Two well-palliated infants died at transplantation. Median survival with duct-dependant pulmonary flow was 183 (0 to 1687) days, with 3 patients well at latest follow-up (56, 55, and 9 months, respectively). There were 2 operative deaths due to ductal spasm and 4 late deaths, 1 due to duct thrombosis, 1 due to chronic lung disease, and 2 of unknown cause. Stent implantation failed in 4 of the 11 cases. Assessment of endothelialization was possible in 13 cases; the stent was partially covered in 3 and fully endothelialized in all 10 cases assessed Ͼ8 weeks after implantation. In patients stented for inadequate pulmonary flow, ductal intimal hyperplasia occurred by 9 months in all 3 survivors but responded to repeated dilation. Conclusions-Ductal stenting cannot be recommended. In patients with HLH, it provides only short-term palliation even when combined with pulmonary artery banding. With duct-dependent pulmonary blood flow, the procedure carries high risk, and duration of palliation is poor. In patients with bilateral ducts and absent central pulmonary arteries, good palliation may be achieved, but repeated angioplasty is necessary to counteract intimal hyperplasia. (Circulation. 1999;99:2621-2625.)

Objective-To assess the feasibility of pulmonary artery banding, atrial septectomy or septostomy, and percutaneous stenting of the arterial duct in babies with the hypoplastic left heart syndrome. Patients Patients and methods Four neonates (birth weights 3 0, 3 7, 4 1, and 3-3 kg) presented in the first week of life with heart failure caused by mitral and aortic atresia with hypoplasia of the left ventricle. Their parents opted for an attempt at palliation. The babies were treated with intravenous prostaglandin E to maintain duct patency. SURGERYThree patients underwent the surgical stage of treatment first, the fourth had the surgical stage of treatment after balloon atrial septostomy and ductal stenting. Surgery was undertaken at the ages of 34, 22, 19, and 11 days respectively. A median sternotomy was performed and the proximal right and left pulmonary arteries were banded with nylon tape (coated with Silastic in three cases), each band was held in place by two Ethibond 5-0 sutures; we attempted to reduce the pulmonary artery diameters by approximately 50%. Open atrial septectomy was performed in the first two babies during a brief (approximately 10 minute) episode of circulatory arrest after cooling to 20°C on cardiopulmonary bypass. The operative procedure was similar in each child, but in the second case the duct was dilated peroperatively with a 10

Anomalous origin of the left coronary artery from the pulmonary artery requires surgical correction. A surgical technique is presented. Two infants underwent re-implantation of their anomalous left coronary arteries by creating a tunnel using autogenous aortic and pulmonary arterial walls. The advantage of this technique is that the new left coronary artery lies in the horizontal plane and in an anatomically correct axis running in the groove behind the pulmonary artery. It also provides a tension free endothelialized autogenous arterial walls with normal growth anticipated.

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LHB is simple, easy and safe to implement, and is the only technique capable of maintaining independent upper and lower body perfusion pressure. Potentially, it provides the best spinal cord protection, and extends the margin of safety and time to execute an accurate repair.