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. 2009 May;30(4):419-25.
doi: 10.1007/s00246-009-9424-3. Epub 2009 Apr 14.

Long-term outcome of palliation with internal pulmonary artery bands after primary heart transplantation for hypoplastic left heart syndrome

Shelley D Miyamoto  1 , Biagio A Pietra, Kak-Chen Chan, David D Ivy, Christine Mashburn, David N Campbell, Max B Mitchell, Mark M Boucek
Affiliations

Long-term outcome of palliation with internal pulmonary artery bands after primary heart transplantation for hypoplastic left heart syndrome

Shelley D Miyamoto et al. Pediatr Cardiol. 2009 May.

Abstract

The purpose of this study was to describe the long-term outcome of infants with hypoplastic left heart syndrome (HLHS) who underwent placement of internal pulmonary artery bands as part of a transcatheter palliation procedure followed by primary heart transplantation. Transcatheter palliation included stenting of the ductus arteriosus, decompression of the left atrium by atrial septostomy, and internal pulmonary artery band placement. Cardiac hemodynamics, pulmonary artery architecture, and pulmonary artery growth since transplantation are described. Nine infants with HLHS had internal pulmonary artery bands placed and underwent successful heart transplant. No infant required reconstruction of the pulmonary arteries at the time of transplant. At 1 year after transplant, all of the recipients had normal mean pulmonary artery pressure, pulmonary vascular resistance, and transpulmonary gradient. Pulmonary angiography performed at 1 year after transplant demonstrated no distortion of pulmonary artery anatomy with significant interval growth of the branch pulmonary arteries. There was 100% survival to hospital discharge after transplant in this cohort of infants. Transcatheter placement of internal pulmonary artery bands for HLHS offers protection of the pulmonary vascular bed while preserving pulmonary artery architecture and growth with good long-term outcome.

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Figures

Fig. 1
Fig. 1
Angiograms of ductus arteriosus stents and internal pulmonary artery bands. a Anteroposterior and b lateral projections of the ductus arteriosus stents and bilateral internal pulmonary artery band devices. The catheter is visualized within the main pulmonary artery segment. c Anteroposterior and d lateral projections after main pulmonary artery angiogram with the palliative devices in place
Fig. 2
Fig. 2
Pulmonary artery angiograms during pulmonary artery band placement and at 1 year after removal. a Fifteen-degree cranial and 15° right anterior oblique angulation and b 30° cranial and 70° left anterior oblique angulation views represent test injections performed during placement of the right and left internal pulmonary artery bands, respectively. c Fifteen-degree cranial and 15° right anterior oblique angulation and d 30° cranial and 70° left anterior oblique angulation views demonstrate a pulmonary artery angiogram obtained 1 year after transplantation as well as removal of the internal pulmonary artery bands
Fig. 3
Fig. 3
Pulmonary artery growth at cardiac catheterization performed approximately 1 year after transplant in the palliated group of patients. Angiography demonstrates significant interval growth of the branch pulmonary arteries, which were 6.4 mm (SD 0.6) for the left artery and 7.3 mm (SD 1.1) for the right artery at the time of placement of the internal pulmonary artery bands, compared with diameters at 1 year after transplant of 8.9 mm (SD 1.4) for the left artery (P<0.01) and 9.5 mm (SD) 1.4 for the right artery (P<0.001)
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