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Hybrid palliation in hypoplastic left heart syndrome

Gutgesell, Howard P; Lim, D Scott

Current Opinion in Cardiology: March 2007 - Volume 22 - Issue 2 - p 55–59
doi: 10.1097/HCO.0b013e328014d945
Pediatrics

Purpose of review Despite progressive improvement in surgical results, hypoplastic left heart syndrome remains one of the congenital heart abnormalities with the greatest morbidity and mortality. Hybrid approaches to management, combining surgical and interventional catheterization procedures, have been introduced to minimize exposure to cardiopulmonary bypass, and improve outcomes for these high-risk infants.

Recent findings First-stage palliation of hypoplastic left heart syndrome has been performed as a hybrid procedure combining surgical pulmonary artery banding with catheterization stenting of the ductus arteriosus and balloon atrial septostomy, especially in high-risk patients. Additionally, several centers have performed second-stage palliation – bidirectional Glenn or hemi-Fontan procedures – in a manner that allows the subsequent ‘Fontan’ procedure to be completed in the catheterization laboratory with a covered stent.

Summary These innovative procedures offer the potential of an alternative management strategy for hypoplastic left heart syndrome. They have been applied to a very limited number of patients and long-term results are not available. Their role in management of hypoplastic left heart syndrome remains to be defined, especially as results of conventional surgical management continue to improve.

Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia Health Science Center, Charlottesville, Virginia

Correspondence to Howard P. Gutgesell MD, Department of Pediatrics, PO Box 800386, University of Virginia Health Science Center, Charlottesville, VA 22908-0386, USA Tel: +1 434 924 2486; fax: +1 434 924 5656; e-mail: hpg@virginia.edu

© 2007 Lippincott Williams & Wilkins, Inc.