title: Bailout shunt/banding for backward left heart failure after adequate neonatal coarctectomy in borderline left hearts.
abstract: To determine the outcome of a bailout procedure using the right ventricle to re-assist the left ventricle in neonates after technically adequate coarctectomy but a failing borderline left heart.
  
  
  
  The surgical procedure was performed on bypass. A 'reversed' 6-mm surgical shunt was inserted between the pulmonary trunk and the descending aorta together with bilateral branch pulmonary artery banding.
  
  
  
  Over a 10-year period, 89 neonates presented with coarctation and small left hearts. In 9 neonates, a hybrid procedure was performed at the outset. The remaining 80 underwent extended end-to-end coarctectomy. Two of these, despite adequate coarctectomy, developed retrograde cardiac failure with supra-systemic pulmonary hypertension, dilating right ventricles and progressive cardiogenic shock. The progressively dilating right ventricles inhibited left ventricular filling. Reversed surgical shunts were performed at 9 and 7 days post-coarctectomy. Both infants recovered rapidly and could be extubated after 4 and 7 days, respectively. Patient 1 proceeded to a univentricular repair and Patient 2 to a biventricular repair.
  
  
  
  Reversed surgical shunt with bilateral banding of the branch pulmonary arteries after neonatal coarctectomy can be successfully employed as a bailout procedure in cases where a borderline left heart with growth potential cannot tolerate a biventricular circulation. It may act as an acute life-saving measure as well as a bridge to later repair. If high risk for backward failure exists in a borderline left heart with catch-up growth potential, a primary hybrid procedure is probably a more elegant and predictable strategy.
authors.affiliation: Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.|Pediatric Cardiology, University of the Free State, Bloemfontein, South Africa.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Brown
authors.affiliation: Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Eyskens
authors.affiliation: Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Derize
authors.initials: D
authors.lastname: Boshoff
authors.affiliation: Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Cools
authors.affiliation: Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Ruth
authors.initials: R
authors.lastname: Heying
authors.affiliation: Congenital Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Filip
authors.initials: F
authors.lastname: Rega
authors.affiliation: Congenital Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Meyns
authors.affiliation: Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium marc.gewillig@uzleuven.be.
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
mesh_terms: D000015:Abnormalities, Multiple; D001017:Aortic Coarctation / Q000175:diagnosis / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery; D007231:Infant, Newborn; D008026:Ligation; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D012086:Reoperation; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Bilateral banding branch pulmonary arteries; Hypoplastic left heart syndrome; Reversed shunt