Stenting of the arterial duct and banding of the pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart.
BACKGROUND
Outcome of patients with hypoplastic left heart (HLH) is mainly influenced by the successful first-step palliation according to the Norwood procedure. An alternative approach is heart transplantation (HTX). The feasibility of ductal stenting in newborns with duct-dependent systemic blood flow and bilateral pulmonary artery banding has been reported. But it remains to be elucidated whether this approach allows a new strategy for patients with HLH.


RESULTS
In patients with various forms of HLH (n=11) and prostaglandin E-1 administration, ductal stenting was performed with balloon expandable Jo stents or Saxx stents. Bilateral pulmonary artery banding was surgically accomplished 1 to 3 days after the transcatheter procedure. Unrestricted blood flow through the interatrial septum was secured by balloon dilatation atrial septotomy, as required. Interventional procedures were performed with no mortality. Stent and ductal patency were achieved for up to 331 days. Two patients underwent HTX, and 8 patients had a palliative 1-stage procedure with reconstruction of the aortic arch and bidirectional cavopulmonary connection at the age of 3.5 to 6 months. There were 2 deaths. One patient with preoperative right heart failure died after the reconstructive surgery, and 1 patient died 4 months after ductal stenting and bilateral banding awaiting HTX.


CONCLUSIONS
The present study is the first clinical trial showing that stenting the duct followed by bilateral pulmonary artery banding in newborns with HLH allows the combination of neoaortic reconstruction, which is part of first-stage palliation of HLH, with the establishment of a bidirectional cavopulmonary connection. Additionally, it allows the chance for HTX after extended waiting periods.
Akintuerk
Hakan
H
Pediatric Heart Center, Justus-Liebig University Giessen, Germany.
Michel-Behnke
Ina
I
Valeske
Klaus
K
Mueller
Matthias
M
Thul
Josef
J
Bauer
Juergen
J
Hagel
Karl-Juergen
KJ
Kreuder
Joachim
J
Vogt
Paul
P
Schranz
Dietmar
D
D000527:Alprostadil / Q000008:administration & dosage; D000792:Angiography; D001013:Aorta, Thoracic / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D006328:Cardiac Catheterization; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects; D004374:Ductus Arteriosus, Patent / Q000601:surgery*; D005500:Follow-Up Studies; D018610:Heart Bypass, Right; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D010092:Oximetry; D010166:Palliative Care; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency
D000527:Alprostadil