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Late catheter interventions in hypoplastic left heart syndrome

Published online by Cambridge University Press:  13 December 2011

Jacqueline Kreutzer ,
Joseph N. Graziano ,
Gary Stapleton  and
Jonathan J. Rome
Jacqueline Kreutzer*
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Pittsburgh, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United states of America
Joseph N. Graziano
Affiliation:
Arizona Pediatric Cardiology Consultants, Phoenix Children's Hospital, Phoenix, Arizona, United states of America
Gary Stapleton
Affiliation:
Pediatric Cardiology, All Children's Hospital, Saint Petersburg, Florida, United states of America
Jonathan J. Rome
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United states of America
*
Correspondence to: Jacqueline Kreutzer, MD, FACC, FSCAI, Associate Professor of Pediatrics, University of Pittsburgh School of Medicine, Director Cardiac Catheterization Laboratory, Children's Hospital of Pittsburgh of UPMC, Children's Hospital Drive, 45th and Penn, Heart Center, 5th Floor Faculty Pavilion, Pittsburgh PA 15201, United States of America. Tel: 412-692-8763; Fax: 412-692-5138; E-mail: jacqueline.kreutzer@chp.edu
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Abstract

Interventional cardiology plays a key role in the diagnosis and management of patients with functionally univentricular physiology after the various stages of surgical palliation. The interventions performed are widely variable in type, including angioplasty of stenotic vessels and implantation of stents in stenotic vessels; closure of defects such as collaterals, leaks in baffles, and fenestrations; creation of fenestration; and more. In the setting of venous hypertension associated with stenosis at the Fontan baffle, conduit, or pulmonary arteries, stent implantation is often preferred, as the aim is to eliminate completely the narrowing, given that relatively mild stenosis can have a significant detrimental hemodynamic effect in patients with functionally univentricular circulation. The procedure is highly successful. In patients who fail after Fontan procedure, creation of a fenestration is often performed, with variable technique depending on the underlying anatomic substrate. To increase chances of patency of the fenestration, implantation of a stent is often required, particularly in the setting of an extracardiac conduit. For those patients with cyanosis and favorable Fontan hemodynamics, closure of the fenestration is performed using atrial septal occluder devices with high success rate. Coils compatible with magnetic resonance imaging are used widely to treat collateral vessels, although on occasion other specific embolization tools are required, such as particles or vascular plugs. Postoperative arch obstruction is successfully managed with angioplasty at a younger age, while implantation of a stent in the aorta is reserved for older patients. Specifics of these interventional procedures as applied to the population of patients with functionally univentricular hearts are described in this manuscript.

Keywords

Cardiac catheterizationpediatric interventional cardiologysingle ventriclefunctionally univentricular heartFontan fenestration

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