Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for various surgical strategies in newborns with multiple left heart obstructive lesions.
OBJECTIVE
To present an institutional experience with stent placement in the arterial duct combined with bilateral banding of the pulmonary artery branches as a basis for various surgical strategies in newborns with hypoplastic left heart obstructive lesions.


METHODS
Observational study.


METHODS
Paediatric heart centre in a university hospital.


METHODS
20 newborns with various forms of left heart obstructive lesions and duct dependent systemic blood flow.


METHODS
Patients underwent percutaneous ductal stenting and surgical bilateral pulmonary artery banding. Atrial septotomy by balloon dilatation was performed as required, in one premature baby by the transhepatic approach.


METHODS
Survival; numbers of and reasons for palliative and corrective cardiac surgery.


RESULTS
One patient died immediately after percutaneous ductal stenting. One patient died in connection with the surgical approach of bilateral pulmonary banding. Stent and ductal patency were achieved for up to 331 days. Two patients underwent heart transplantation and two patients died on the waiting list. Ten patients had a palliative one stage procedure with reconstruction of the aortic arch and bidirectional cavopulmonary connection at the age of 3.5-6 months. There was one death. One patient is still awaiting this approach. Two patients received biventricular repair. In one, biventricular repair will soon be provided.


CONCLUSIONS
Stenting the arterial duct combined with bilateral pulmonary artery banding in newborns with hypoplastic left heart or multiple left heart obstructive lesions allows a broad variation of surgical strategies depending on morphological findings, postnatal clinical conditions, and potential ventricular growth.
Paediatric Heart Centre, Justus-Liebig University Giessen, Giessen, Germany. Ina.Michel-Behnke.@paediat.med.uni-giessen.de
I
I
Michel-Behnke
H
H
Akintuerk
I
I
Marquardt
M
M
Mueller
J
J
Thul
J
J
Bauer
K J
KJ
Hagel
J
J
Kreuder
P
P
Vogt
D
D
Schranz
D006328:Cardiac Catheterization / Q000379:methods; D002303:Cardiac Output, Low / Q000209:etiology; D016887:Cardiopulmonary Resuscitation; D004373:Ductus Arteriosus / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D010166:Palliative Care; D011651:Pulmonary Artery / Q000002:abnormalities*; D019651:Plastic Surgery Procedures / Q000379:methods; D015607:Stents; D016019:Survival Analysis