Long-Term Outcome of Palliation with Internal Pulmonary Artery Bands After Primary Heart Transplantation for Hypoplastic Left Heart Syndrome
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.
Full-textDOI: · Available from: David Dunbar Ivy, May 30, 2015
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ABSTRACT: Pediatric interventional cardiology has evolved quite dramatically over the past few decades and now, in 2009, the published literature continues to evolve new percutaneous strategies for managing patients with congenital heart disease, both simple and complex. Our goal for this review was to highlight new techniques and the new devices available to the pediatric interventional cardiologist, and to review the outcomes from past endeavors. Manuscripts published in the past year continue to demonstrate innovation; indicating an exciting and increasing experience of transcatheter treatment of septal communications using either new occluder devices or novel techniques. Bioabsorbable devices and percutaneously implanted valves are leading examples of technological improvements and creativity that will ultimately improve patient outcomes while minimizing invasiveness. Reports on procedural outcomes show technically safe early follow-up, with promising mid-term and long-term results for balloon valvuloplasty, balloon atrial septostomy and pulmonary artery stent implantation. As well, fetal and hybrid interventions have become important new arenas for the pediatric interventionist. Pediatric interventions have grown far beyond the early stages of the 1980s as mid-term and long-term outcome data are being reported, and many previously insurmountable hurdles have been overcome by developing new strategies and devices.Current opinion in pediatrics 10/2010; 22(5):567-72. DOI:10.1097/MOP.0b013e32833e1328 · 2.74 Impact Factor