Stenting of the arterial duct and banding of the pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart.

نویسندگان

  • Hakan Akintuerk
  • Ina Michel-Behnke
  • Klaus Valeske
  • Matthias Mueller
  • Josef Thul
  • Juergen Bauer
  • Karl-Juergen Hagel
  • Joachim Kreuder
  • Paul Vogt
  • Dietmar Schranz
چکیده

BACKGROUND Outcome of patients with hypoplastic left heart (HLH) is mainly influenced by the successful first-step palliation according to the Norwood procedure. An alternative approach is heart transplantation (HTX). The feasibility of ductal stenting in newborns with duct-dependent systemic blood flow and bilateral pulmonary artery banding has been reported. But it remains to be elucidated whether this approach allows a new strategy for patients with HLH. METHODS AND RESULTS In patients with various forms of HLH (n=11) and prostaglandin E-1 administration, ductal stenting was performed with balloon expandable Jo stents or Saxx stents. Bilateral pulmonary artery banding was surgically accomplished 1 to 3 days after the transcatheter procedure. Unrestricted blood flow through the interatrial septum was secured by balloon dilatation atrial septotomy, as required. Interventional procedures were performed with no mortality. Stent and ductal patency were achieved for up to 331 days. Two patients underwent HTX, and 8 patients had a palliative 1-stage procedure with reconstruction of the aortic arch and bidirectional cavopulmonary connection at the age of 3.5 to 6 months. There were 2 deaths. One patient with preoperative right heart failure died after the reconstructive surgery, and 1 patient died 4 months after ductal stenting and bilateral banding awaiting HTX. CONCLUSIONS The present study is the first clinical trial showing that stenting the duct followed by bilateral pulmonary artery banding in newborns with HLH allows the combination of neoaortic reconstruction, which is part of first-stage palliation of HLH, with the establishment of a bidirectional cavopulmonary connection. Additionally, it allows the chance for HTX after extended waiting periods.

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منابع مشابه

CONGENITAL HEART DISEASE Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for various surgical strategies in newborns with multiple left heart obstructive lesions

Objective: To present an institutional experience with stent placement in the arterial duct combined with bilateral banding of the pulmonary artery branches as a basis for various surgical strategies in newborns with hypoplastic left heart obstructive lesions. Design: Observational study. Setting: Paediatric heart centre in a university hospital. Patients: 20 newborns with various forms of left...

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Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for various surgical strategies in newborns with multiple left heart obstructive lesions.

OBJECTIVE To present an institutional experience with stent placement in the arterial duct combined with bilateral banding of the pulmonary artery branches as a basis for various surgical strategies in newborns with hypoplastic left heart obstructive lesions. DESIGN Observational study. SETTING Paediatric heart centre in a university hospital. PATIENTS 20 newborns with various forms of le...

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Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome.

OBJECTIVE To assess the feasibility of pulmonary artery banding, atrial septectomy or septostomy, and percutaneous stenting of the arterial duct in babies with the hypoplastic left heart syndrome. PATIENTS Four infants with hypoplastic left heart syndrome. SETTING Two supraregional paediatric cardiac centres. METHODS Ductal patency was maintained initially with prostaglandin E. Banding of...

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Use of mathematical modeling to compare and predict hemodynamic effects between hybrid and surgical Norwood palliations for hypoplastic left heart syndrome.

BACKGROUND Combining bilateral pulmonary artery banding with arterial duct stenting, the hybrid approach achieves stage 1 palliation for hypoplastic left heart syndrome with different flow characteristics than those after the surgical Norwood procedures. Accordingly, we used computational modeling to assess some of these differences, including influence on systemic and cerebral oxygen deliverie...

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Hybrid approach for hypoplastic left heart syndrome and its variants: the fate of the pulmonary arteries.

OBJECTIVES To analyse the results of hybrid palliation of hypoplastic left heart syndrome (HLHS) patients and its variants with an emphasis on the long-term fate of the pulmonary arteries. METHODS We analysed 28 neonates (2006-11) with HLHS and its variants, who underwent bilateral pulmonary artery banding, patent ductus arteriosus (PDA) stenting and balloon atrial septostomy using a true hyb...

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عنوان ژورنال:
  • Circulation

دوره 105 9  شماره 

صفحات  -

تاریخ انتشار 2002