Cardiac catheterization and interventional procedures as part of staged surgical palliation for hypoplastic left heart syndrome

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 SaO(2) 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.