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- Title
Cardiac Catheterization and Interventional Procedures as Part of Staged Surgical Palliation for Hypoplastic Left Heart Syndrome.
- Authors
Hansen, Jan Hinnerk; Runge, Ute; Uebing, Anselm; Scheewe, Jens; Kramer, Hans-Heiner; Fischer, Gunther
- Abstract
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 SaO2 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. Conclusion. 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.
- Subjects
CARDIAC catheterization; PALLIATIVE treatment; HYPOPLASTIC left heart syndrome; TRANSLUMINAL angioplasty; STENOSIS; CENTRAL venous pressure; THERAPEUTICS
- Publication
Congenital Heart Disease, 2012, Vol 7, Issue 6, p565
- ISSN
1747-079X
- Publication type
Article
- DOI
10.1111/j.1747-0803.2012.00709.x