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A 10-year single-centre experience in percutaneous interventions for multi-stage treatment of hypoplastic left heart syndrome

  • Tomasz Moszura (a1), Pawel Dryzek (a1), Sebastian Goreczny (a1), Anna Mazurek-Kula (a1), Jacek J. Moll (a2), Andrzej Sysa (a1), Waldemar Bobkowski (a3), Jadwiga A. Moll (a1) and Shakeel A. Qureshi (a4)...



The purpose of this paper is to report our 10 years of experience of interventional treatment of patients with hypoplastic left heart syndrome and to focus on the frequency, type, and results of percutaneous interventions during all the stages of palliation, considering the different techniques, devices, and complications.


Constant progress in surgical treatment of congenital heart defects in the last decade has significantly improved the prognosis for children with hypoplastic left heart syndrome. However, morbidity and mortality remain relatively high. Modern interventional procedures complement or occasionally replace surgical treatment.


Between January, 2001 and December, 2010, 161 percutaneous interventions were performed in 88 patients with hypoplastic left heart syndrome. Patients were divided into four groups: (a) before the first surgical treatment including hybrid approach, (b) after first-stage Norwood operation, (c) after second-stage bidirectional Glenn operation, and (d) after third-stage Fontan operation.


Percutaneous interventions resulted in statistically significant changes in pulmonary artery pressures, vessel diameters, and O2 saturation. Complications occurred in 4.3% of interventions and were related mainly to stent implantation in stenosed pulmonary arteries.


Percutaneous interventions may result in haemodynamic stability and reduction in the number of operations. They may result in significant changes in pulmonary artery pressures, vessel diameters, O2 saturation, with a low rate of complications, which are mainly related to stent implantation in the pulmonary arteries.


Corresponding author

Correspondence to: Dr S. Goreczny, MD, Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Rzgowska 281/289, 93347 Lodz, Poland. Tel: (+48) 422712184; Fax: (+48) 422711478; E-mail:


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1. Januszewska, K, Kozlik-Feldmann, R, Kordon, Z, et al. Significance of the residual aortic obstruction in multistage repair of hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2011; 40 (2): 508513.
2. Barron, DJ, Kilby, MD, Davies, B, Wright, JG, Jones, TJ, Brawn, WJ. Hypoplastic left heart syndrome. Lancet 2009; 374: 551564.
3. Nakano, T, Fukae, K, Sonoda, H, et al. Follow-up study of pulmonary artery configuration in hypoplastic left heart syndrome. Gen Thorac Cardiovasc Surg 2008; 56: 6162.
4. Heinemann, M, Breuer, J, Steger, V, Steil, E, Sieverding, L, Ziemer, G. Incidence and impact of systemic venous collateral development after Glenn and Fontan procedures. Thorac Cardiovasc Surg 2001; 49: 172178.
5. Moszura, T, Mazurek-Kula, A, Dryzek, P, et al. Interventions complementing surgery as part of multistage treatment for hypoplastic left heart syndrome: one center's experience. Pediatr Cardiol 2009; 30: 106113.
6. Akintuerk, H, Michel-Behnke, I, Valeske, K, et al. Stenting of the arterial duct and banding of the pulmonary arteries: basis for combined Norwood stage I and II repair in hypoplastic left heart. Circulation 2002; 105: 10991103.
7. Bacha, EA, Hijazi, ZM. Hybrid procedures in pediatric cardiac surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005; 8: 7885.
8. Pedra, CA, Neves, JR, Pedra, SR, et al. New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease. Catheter Cardiovasc Interv 2007; 70: 731739.
9. Gewillig, M, Boshoff, D, Mertens, L. Creation with a stent of unrestrictive lasting atrial communication. Cardiol Young 2001; 12: 408411.
10. Stumper, O, Gewillig, M, Vettukattil, J, et al. Modified technique of stent fenestration of the atrial septum. Heart 2003; 89: 12271230.
11. McCrindle, BW, Blackstone, EH, Williams, WG, et al. Are outcomes of surgical versus transcatheter balloon valvotomy equivalent in neonatal critical aortic stenosis? Circulation 2001; 104: 152158.
12. Rhodes, LA, Colan, SD, Perry, SB, Jonas, RA, Sanders, SP. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991; 84: 23252335.
13. Schwartz, ML, Gauvreau, K, Geva, T. Predictors of outcome of biventricular repair in infants with multiple left heart obstructive lesions. Circulation 2001; 104: 682687.
14. Januszewska, K, Stebel, A, Malec, E. Consequences of right ventricle-to-pulmonary artery shunt at the first stage for the Fontan operation. Ann Thorac Surg 2007; 84: 16111617.
15. Muyskens, S, Nicolas, R, Foerster, S, Balzer, D. Endovascular stent placment for right ventricle to pulmonary artery conduit stenosis in the Norwood with Sano modification. Congenit Heart Dis 2008; 3 (3): 185190.
16. Dasi, LP, Sundareswaran, KS, Sherwin, C, et al. Larger aortic reconstruction corresponds to diminished left pulmonary artery size in patients with single-ventricle physiology. J Thorac Cardiovasc Surg 2010; 139: 557561.
17. Chessa, M, Dindar, A, Vettukattil, JJ, et al. Balloon angioplasty in infants with aortic obstruction after the modified stage I Norwood procedure. Am Heart J 2000; 140: 227231.
18. Moszura, T, Mazurek-Kula, A, Dryżek, P, Moll, JA, Moll, JJ, Sysa, A. Interventional procedures for patients with hypoplastic left heart syndrome and elevated pulmonary pressure. Pol Przegl Kardiol 2008; 3: 202206.
19. Douglas, WI, Goldberg, CS, Mosca, RS, Law, IH, Bove, EL. Hemi-Fontan procedure for hypoplastic left heart syndrome: outcome and suitability for Fontan. Ann Thorac 2007; 22: 5559.
20. Ruiz, CE, Gamra, H, Zhang, HP, García, EJ, Boucek, MM. Brief report: stenting of the ductus arteriosus as a bridge to cardiac transplantation in infants with the hypoplastic left-heart syndrome. N Engl J Med 1993; 328: 16051608.
21. Kopf, GS, Kleinman, CS, Hijazi, ZM, Fahey, JT, Dewar, ML, Hellenbrand, WE. Fenestrated Fontan operation with delayed transcatheter closure of atrial septal defect. Improved results in high-risk patients. J Thorac Cardiovasc Surg 1992; 103: 10391047.
22. de Leval, MR. Evolution of the Fontan-Kreutzer procedure. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2010; 13: 9195.
23. Goff, DA, Blume, ED, Gauvreau, K, Mayer, JE, Lock, JE, Jenkins, KJ. Clinical outcome of fenestrated Fontan patients after closure: the first 10 years. Circulation 2000; 102: 20942099.
24. Alva, C, David, F, Ortegón, J, Sánchez, A, López, D, Ledesma, M. Transcatheter closure of secundum atrial septal defects and fenestrated Fontan using the Amplatzer septal occluder. Initial prospective study. Arch Cardiol Mex 2003; 73: 185189.
25. Moszura, T, Mazurek-Kula, A, Dryzek, P, Sysa, A. Bronchial compression as adverse effect of left pulmonary artery stenting in a patient with hypoplastic left heart syndrome. Pediatr Cardiol 2010; 31: 530533.
26. Agnoletti, G, Bonnet, C, Boudjemline, Y, et al. Complications of paediatric interventional catheterisation: an analysis of risk factors. Cardiol Young 2005; 15: 402408.
27. Moszura, T, Świątnicka-Lucińska, M, Dryżek, P, et al. Complications during anaesthesia for diagnostic and interventional cardiac procedures in children with congenital heart defects. Pol Przegl Kardiol 2009; 11: 177180.
28. McElhinney, DB, Bergersen, L, Marshall, AC. In situ fracture of stents implanted for relief of pulmonary arterial stenosis in patients with congenitally malformed hearts. Cardiol Young 2008; 18: 405414.
29. Knirsch, W, Haas, NA, Lewin, MA, Uhlemann, F. Longitudinal stent fracture 11 months after implantation in the left pulmonary artery and successful management by a stent-in-stent maneuver. Catheter Cardiovasc Interv 2004; 58: 116118.
30. Antón-Pacheco, JL, Cabezalí, D, Tejedor, R, et al. The role of airway stenting in pediatric tracheobronchial obstruction. Eur J Cardiothorac Surg 2008; 33: 10691075.
31. Pihkala, J, Yazaki, S, Mehta, R, et al. Feasibility and clinical impact of transcatheter closure of interatrial communications after a fenestrated Fontan procedure: medium-term outcomes. Catheter Cardiovasc Interv 2007; 69: 10071014.


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A 10-year single-centre experience in percutaneous interventions for multi-stage treatment of hypoplastic left heart syndrome

  • Tomasz Moszura (a1), Pawel Dryzek (a1), Sebastian Goreczny (a1), Anna Mazurek-Kula (a1), Jacek J. Moll (a2), Andrzej Sysa (a1), Waldemar Bobkowski (a3), Jadwiga A. Moll (a1) and Shakeel A. Qureshi (a4)...


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