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Implantation of stents to ensure an adequate interatrial communication in patients with hypoplastic left heart syndrome

Published online by Cambridge University Press:  01 October 2007

Stefan Rupp ,
Ina Michel-Behnke ,
Klaus Valeske ,
Hakan Akintürk  and
Dietmar Schranz
Stefan Rupp
Affiliation:
Paediatric Heart Centre, University Clinic Giessen-Marburg, Germany
Ina Michel-Behnke
Affiliation:
Paediatric Heart Centre, University Clinic Giessen-Marburg, Germany
Klaus Valeske
Affiliation:
Paediatric Heart Centre, University Clinic Giessen-Marburg, Germany
Hakan Akintürk
Affiliation:
Paediatric Heart Centre, University Clinic Giessen-Marburg, Germany
Dietmar Schranz*
Affiliation:
Paediatric Heart Centre, University Clinic Giessen-Marburg, Germany
*
Correspondence to: Dietmar Schranz, MD, Paediatric Heart Centre, Justus-Liebig University, Feulgenstraße 12, 35385 Giessen, Germany. Tel: 0049 641 994 3461; Fax: 0049 641 994 3469; E-mail: dietmar.schranz@paediat.med.uni-giessen.de
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Abstract

Aims

To assess the feasibility of interatrial stenting for left atrial decompression in infants with hypoplastic left heart syndrome treated by a “hybrid-approach”, with bilateral surgical banding of the pulmonary arteries and percutaneous stenting of the arterial duct.

Patients and methods

We stented the atrial septum in 5 infants aged from 21 to 77 days, making the intervention as an elective procedure in 4, but as a rescue procedure in the fifth patient, who had a restrictive foramen. The stents, comprising 2 Jo-stents of 17 millimetres hand-crimped on a balloon catheter with dimensions of 10 by 20 millimetres, and 3 premounted Genesis stents with dimensions of 10 by 19 millimetres, were placed using a 6 French long or short sheath by femoral venous access. The stents were expanded under fluoroscopic guidance to create a slightly diabolo-shaped form that fitted the septum.

Results

The percutaneous interventions were successfully performed in all cases, producing significant improvement in clinical condition after placement. The saturations of oxygen increased from an average of 64% plus or minus 18% to 88% plus or minus 7%, (p < 0.05). During a mean follow up of 2.5 months, without any anticoagulant therapy, there were no complications related to the stenting. Surgical removal of the stents was uneventful during reconstruction of the aortic arch and creation of a bidirectional cavopulmonary connection in 4 patients, and during cardiac transplantation in one.

Conclusion

In the context of the hybrid approach, definitive decompression of the left atrium can be achieved by stenting the atrial septum in infants with hypoplastic left heart syndrome. Placement of the stents is safe and effective, with insertion in the form of a diabolo reducing the risk of dislocation, as well as embolisation of the stent.

Keywords

Hypoplastic left heart syndromehybrid approachpulmonary hypertension
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 5 , October 2007 , pp. 535 - 540
Copyright
Copyright © Cambridge University Press 2007

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