Hypoplastic left heart syndrome with intact or highly restrictive atrial septum: outcome after neonatal transcatheter atrial septostomy.
BACKGROUND
Hypoplastic left heart syndrome (HLHS) with intact or very restrictive atrial septum is a highly lethal combination. We review our 13-year institutional experience treating this high-risk subgroup of patients with emergent catheter therapy.


RESULTS
Infants with HLHS requiring catheter septostomy within the first 2 days of life were compared with a matched control group with adequate interatrial communication. Preoperative, early postoperative, and medium-term survival were evaluated. Earlier experience was compared with recent results to assess the effect of changes in catheterization and surgical and intensive care unit management strategies over the study period. From 1990 to 2002, 33 newborns with HLHS (11% of newborns with HLHS managed during this period) underwent urgent/semiurgent catheterization to create or enlarge an interatrial communication before surgical palliation. Preoperative and early postoperative mortality were high (48%) compared with control HLHS patients, regardless of prenatal diagnosis and despite successful catheter-based atrial septostomy with clinical stabilization. Mortality trended down during the later part of the study period. Those who survived the neonatal period had late survival, pulmonary artery pressure, and resistance similar to those of control subjects.


CONCLUSIONS
Neonatal mortality in the subgroup of HLHS patients with intact or highly restrictive atrial septum remains high despite successful urgent septostomy. Persistently poor outcomes for these patients have prompted efforts at our center to develop techniques for fetal intervention for this condition, in the hope that prenatal relief of left atrial and pulmonary venous hypertension may promote normal pulmonary vascular and parenchymal development and improve both short- and long-term outcomes.
Vlahos
Antonios P
AP
Department of Cardiology, Children's Hospital, and Pediatrics, Harvard Medical School, Boston, Mass, USA.
Lock
James E
JE
McElhinney
Doff B
DB
van der Velde
Mary E
ME
D006328:Cardiac Catheterization / Q000379:methods / Q000706:statistics & numerical data; D016022:Case-Control Studies; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation; D005318:Fetal Heart / Q000002:abnormalities / Q000000981:diagnostic imaging; D005544:Forecasting; D006325:Heart Atria / Q000473:pathology / Q000601:surgery*; D006346:Heart Septum / Q000473:pathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000196:embryology / Q000473:pathology / Q000601:surgery*; D007231:Infant, Newborn; D015993:Life Tables; D008168:Lung / Q000473:pathology; D042601:Lymphatic Vessels / Q000473:pathology; D010166:Palliative Care; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal