Cardiac catheterization and interventional procedures as part of staged surgical palliation for hypoplastic left heart syndrome.
BACKGROUND
Cardiac catheterization and interventional procedures are an important part of staged surgical palliation for hypoplastic left heart syndrome (HLHS).


METHODS
We reviewed our experience of interventional procedures for HLHS patients treated between 01/1996 and 12/2010.


RESULTS
Overall, 222 neonates received a Norwood operation. Of them, 181 underwent 554 catheterizations with 243 interventions. Recoarctation was treated by balloon angioplasty (BA) in 46 patients. The pressure gradient dropped from 29 ± 14 mm Hg to 6 ± 7 mm Hg (P <.001); the diameter of the stenosis increased by 61 ± 33% (P <.001). Restenosis occurred in 16 cases and a higher initial gradient was predictive for the need of reintervention (odds ratio [OR] 1.057 [1.008-1.109] per 1 mm Hg increase, P =.022). The pressure gradient after reintervention was higher compared to the results of the first intervention (11 ± 7 mm Hg vs. 6 ± 7 mm Hg, P =.023). Aortopulmonary collaterals were detected in 25% (44/178) before hemi-Fontan operation, in 86% (117/136) before and in 37% (33/90) after Fontan completion. They were occluded in 98 patients during 119 catheterizations. Right-to-left shunts were found in 37 cases, mainly after Fontan completion (30/37). The baffle fenestration was closed in 48 of 90 patients after Fontan completion. Central venous pressure slightly increased (13.3 ± 1.7 mm Hg to 14.1 ± 1.9 mm Hg, P =.008) and SaO(2) increased from 88 ± 5% to 96 ± 2% (P <.001). Pulmonary artery stenosis was detected in nine of 136 patients after hemi-Fontan operation and addressed by catheter intervention in three cases (BA n = 2, stent implantation n = 1). Furthermore, miscellaneous interventions were performed during 12 catheterizations.


CONCLUSIONS
Although BA for recoarctation showed good acute results, the need for later reintervention is remarkably high. A higher initial gradient was predictive for restenosis. Pulmonary artery stenosis was a relatively rare problem and might be less likely with the hemi-Fontan technique.
Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. jan.hansen@uk-sh.de
Jan Hinnerk
JH
Hansen
Ute
U
Runge
Anselm
A
Uebing
Jens
J
Scheewe
Hans-Heiner
HH
Kramer
Gunther
G
Fischer
D000293:Adolescent; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D062186:Arterial Pressure; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation; D003251:Constriction, Pathologic; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation; D018729:Fontan Procedure; D006439:Hemodynamics; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D058327:Norwood Procedures / Q000009:adverse effects; D016017:Odds Ratio; D010166:Palliative Care; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014690:Venous Pressure