Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome.

Abstract

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

Congenital heart defects in Kabuki syndrome

“…The surgical treatment of the congenital heart defects in KS, may start early in even neonates. Stenting of the arterial duct along with restricting pulmonary blood fl ow has been utilized in many centers to avoid cardiopulmonary bypass in the neonatal cases [32]. Simpler heart defects including coarctation of the aorta, aortic stenosis, atrial and ventricular septal defects, atrioventricular canal and Ebstein's anomaly can be repaired with minimally invasive/robotic assisted surgery [33][34][35].…”

Fate of the Stented Arterial Duct

“…The technical details of stent implantation have been described previously. 3,4 Ethics committee approval was obtained for the studies.…”

“…[3][4][5] This report describes our experience with ductal stenting over 6 years, with maximum patient follow-up of 53 months.…”

The hybrid approach for palliation of hypoplastic left heart syndrome: Intermediate results of a single-center experience

“…10---12 For this subgroup of patients, a hybrid approach ---combining transcatheter and surgical techniques ---was devised in the last decade, aiming to combine the best characteristics of surgical and interventional cardiology techniques. 13---15 Originally reported in 1993, 16 hybrid stage 1 palliation consists of bilateral branch pulmonary artery banding and stenting of the ductus arteriosus, without cardiopulmonary bypass, during the neonatal period. Assurance of a nonrestrictive atrial septal defect is the next step, through either balloon atrial septostomy or stenting.…”