Fate of the Ductal Stent After Hybrid Palliation for Hypoplastic Left Heart Syndrome

Neutrophil/Lymphocyte Ratio and Association with Arch Intervention in Patients with Hypoplastic Left Heart Syndrome Undergoing Hybrid Procedure

“…[3][4][5] Undoubtedly, anatomical issues may place these patients at increased risk for arch intervention if one starts with a narrow orifice, but the underlying cause of ongoing stenosis is likely secondary to inflammation and fibrosis due to the PDA stent. 7,8 The velocity changes on the echocardiogram are the expected alterations seen with worsening stenosis secondary to the fibrosis.…”

“…Previous studies in patients undergoing the hybrid procedure have shown that patients with aortic atresia diagnosis, smaller aortic root size, increased weight, and angle of the insertion of the PDA to the aortic arch were associated with a subsequent intervention either in the PDA or retro-aortic arch. [3][4][5]7 In addition, higher initial velocities and increased rate of velocity change in the PDA or retro-aortic arch via echocardiographic evaluation were associated with an interventional procedure. [5][6][7] Other baseline values such as gender, timing of procedure, type of stent, and oxygen saturation were not associated with an intervention.…”

“…[3][4][5]7 In addition, higher initial velocities and increased rate of velocity change in the PDA or retro-aortic arch via echocardiographic evaluation were associated with an interventional procedure. [5][6][7] Other baseline values such as gender, timing of procedure, type of stent, and oxygen saturation were not associated with an intervention. [3][4][5] Undoubtedly, anatomical issues may place these patients at increased risk for arch intervention if one starts with a narrow orifice, but the underlying cause of ongoing stenosis is likely secondary to inflammation and fibrosis due to the PDA stent.…”

“…This complication is associated with increased mortality for these patients. 3 Various echocardiographic and angiographic measurements have been used to predict if this complica-tion will occur, [4][5][6][7] but the underlying stenosis is likely due to an inflammatory process causing subsequent fibrosis. 8 In adult studies, neutrophil %, lymphocyte %, and neutrophil/lymphocyte (N/L) ratio have been used as markers for inflammation.…”

The Evolution of Therapeutic Strategies: Niche Apportionment for Hybrid Palliation

“…Ductal stenting has been associated with retrograde aortic arch obstruction and impaired coronary and cerebral blood flow. The need for reintervention on the ductal stent has been stressed as well as the importance to cover the whole length of the duct to ensure patency [33]. However, stent protrusion across the isthmus can lead to retrograde aortic arch obstruction.…”