title: Catheter interventions in the staged management of hypoplastic left heart syndrome.
abstract: OBJECTIVE
  To analyse the current practice and contribution of catheter interventions in the staged management of patients with hypoplastic left heart syndrome.
  
  
  METHODS
  This study is a retrospective case note review of 527 patients undergoing staged Norwood/Fontan palliation at a single centre between 1993 and 2010. Indications and type of catheter interventions were reviewed over a median follow-up period of 7.5 years.
  
  
  RESULTS
  A staged Norwood/Fontan palliation for hypoplastic left heart syndrome was performed in 527 patients. The 30-day survival rate after individual stages was 76.5% at Stage I, 96.3% at Stage II, and 99.4% at Stage III. A total of 348 interventions were performed in 189 out of 527 patients. Freedom from catheter intervention in survivors was 58.2% before Stage II and 46.7% before Stage III. Kaplan-Meier freedom from intervention post Fontan completion was 55% at 10.8 years of follow-up. Post-stage I interventions were mostly directed to relieve aortic arch obstruction--84 balloon angioplasties--and augment pulmonary blood flow--15 right ventricle-to-pulmonary conduit interventions; post-Stage II interventions centred on augmenting size of the left pulmonary artery--73 procedures and abolishing systemic venous collaterals--32 procedures. After Stage III, the focus was on manipulating the size of the fenestration--42 interventions--and the left pulmonary artery -31 procedures.
  
  
  CONCLUSIONS
  Interventional cardiac catheterisation constitutes an integral part in the staged palliative management of patients with hypoplastic left heart syndrome. Over one-third (37%) of patients undergoing staged palliation required catheter intervention over the follow-up period.
authors: Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
authors: Zdenka
authors: Z
authors: Reinhardt
authors: Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
authors: Joseph
authors: J
authors: De Giovanni
authors: Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
authors: John
authors: J
authors: Stickley
authors: Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
authors: Vinay K
authors: VK
authors: Bhole
authors: Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
authors: Benjamin
authors: B
authors: Anderson
authors: Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
authors: Bari
authors: B
authors: Murtuza
authors: Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
authors: Chetan
authors: C
authors: Mehta
authors: Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
authors: Paul
authors: P
authors: Miller
authors: Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
authors: Rami
authors: R
authors: Dhillon
authors: Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
authors: Oliver
authors: O
authors: Stumper
mesh_terms: D001017:Aortic Coarctation / Q000601:surgery*; D054087:Atrial Septum / Q000601:surgery*; D058366:Blalock-Taussig Procedure / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods*; D015331:Cohort Studies; D003097:Collateral Circulation; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000379:methods; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies