Hybrid palliation in hypoplastic left heart syndrome.
OBJECTIVE
Despite progressive improvement in surgical results, hypoplastic left heart syndrome remains one of the congenital heart abnormalities with the greatest morbidity and mortality. Hybrid approaches to management, combining surgical and interventional catheterization procedures, have been introduced to minimize exposure to cardiopulmonary bypass, and improve outcomes for these high-risk infants.


RESULTS
First-stage palliation of hypoplastic left heart syndrome has been performed as a hybrid procedure combining surgical pulmonary artery banding with catheterization stenting of the ductus arteriosus and balloon atrial septostomy, especially in high-risk patients. Additionally, several centers have performed second-stage palliation - bidirectional Glenn or hemi-Fontan procedures - in a manner that allows the subsequent 'Fontan' procedure to be completed in the catheterization laboratory with a covered stent.


CONCLUSIONS
These innovative procedures offer the potential of an alternative management strategy for hypoplastic left heart syndrome. They have been applied to a very limited number of patients and long-term results are not available. Their role in management of hypoplastic left heart syndrome remains to be defined, especially as results of conventional surgical management continue to improve.
Gutgesell
Howard P
HP
Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia Health Science Center, Charlottesville, Virginia 22908-0386, USA. hpg@virginia.edu
Lim
D Scott
DS
D019917:Blood Vessel Prosthesis Implantation; D006328:Cardiac Catheterization; D002404:Catheterization; D004373:Ductus Arteriosus / Q000601:surgery; D018729:Fontan Procedure / Q000009:adverse effects; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery / Q000628:therapy*; D010166:Palliative Care / Q000379:methods; D011651:Pulmonary Artery / Q000601:surgery; D015607:Stents