Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the short-to-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction.

Background: In spite of the advances in sepsis diagnosis and treatment in the last years, the morbidity and mortality are still high.

Between May 1975 and August 1991, 184 patients with transposition of the great arteries (TGA) were operated upon by Jatene operation. One hundred and sixteen underwent corrective surgery prior to June 1987 with a follow-up period of between 50 and 182 months. The ages of these 116 patients ranged from 1 day to 84 months (11.53 +/- 15.98). Eleven percent were less than 1 month old, 38% were between 1 and 6 months, 29% between 7 and 12 months and 22% were older than this. Eighty-eight patients (76%) were boys and the weight ranged from 2.4 to 17.0 kg (6.39 +/- 3.38). Thirty-eight patients (20.7%) died in the immediate postoperative period. Of the survivors, 5 died in the late follow-up between 9 and 66 months (endocarditis at 9 and 66 months; gastroenteritis at 20 months; sudden death at 48 months; and during reoperation for relief of pulmonary stenosis (PS) at 60 months). Of the surviving 73 patients, 24 (32.9%) are anatomically normal at a mean period of 92.5 months postoperatively. Twenty-two (30.1%) have dysfunctions without clinical repercussion. Nineteen (26%) have had no recent evaluation and 8 (11%) were submitted to reoperation or angioplasty for relief of PS. Ninety-eight percent of the patients have normal left ventricular function. The majority of the patients surviving 50 to 182 months are in good clinical condition and if dysfunctions are present these show no progression or severe hemodynamic alterations.

Initial surgical reconstruction for hypoplastic left heart syndrome (HLHS) is associated with satisfactory outcomes only in a few referral centers. Moreover, there is a persistent high-risk period for sudden death while the patient waits for the next surgical procedure. The development of a less invasive approach, so-called "hybrid," postponing a major surgery outside the neonatal period, might reduce the immediate and late surgical burden on these patients. This is a retrospective study of a contemporary series of patients with HLHS seen in two separate institutions. Patients with HLHS or its variants who underwent a "hybrid" management were included in the study. Data are described as the mean and standard deviation or absolute numbers and percentage, as appropriate. From January 2004 to June 2006, 15 patients (10 male; 5 +/- 3.8 days old and 2.9 +/- 0.5 kg) were included in the study. Ten had both mitral and aortic atresia; the ascending aorta and atrial septal defect measured 2.5 +/- 1.4 and 4.9 +/- 1.2 mm, respectively. There were six hospital survivors after stage I (mortality rate 60%). During the interstage period, all but one patient needed additional procedures. One patient died of bacterial meningitis 4 months after stage I. Four patients were submitted to stage II operation at 6.6 +/- 0.5 months of age and one is waiting for the operation. All four required early reinterventions for pulmonary artery stenosis. Only one was discharged home and was not yet submitted to the third stage. The hybrid approach for HLHS was associated with poor results in this early experience from two independent institutions in a developing country. This might have been related to infrastructure and technical problems, as well as our own learning curve. Institutions working under the same conditions might face similar problems during their initial experience.

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