Circulation. 2002;105:1099-1103
Published online before print February 4, 2002, doi: 10.1161/hc0902.104709
Published online before print February 4, 2002, doi: 10.1161/hc0902.104709
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(Circulation. 2002;105:1099.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Stenting of the Arterial Duct and Banding of the Pulmonary Arteries
Basis for Combined Norwood Stage I and II Repair in Hypoplastic Left Heart
From the Pediatric Heart Center, Justus-Liebig University Giessen, Germany.
Correspondence to Dietmar Schranz, MD, Pediatric Heart Center, Justus-Liebig University, Feulgenstraße 12, 35385 Giessen, Germany. E-mail Dietmar.Schranz{at}paediat.med.uni-giessen.de
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.
Key Words: ductus arteriosus, patent • stents • pediatrics • heart defects, congenital
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