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Atrial septal defect morphology and stenting in hypoplastic left heart syndrome after hybrid palliation

Published online by Cambridge University Press:  11 September 2017

Lilia Oreto*
Affiliation:
Bambino Gesù Pediatric Hospital, Mediterranean Pediatric Cardiology Center, Taormina, Messina, Italy Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Giuseppe Mandraffino
Affiliation:
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Lucia Manuri
Affiliation:
Bambino Gesù Pediatric Hospital, Mediterranean Pediatric Cardiology Center, Taormina, Messina, Italy
Michele B. Saitta
Affiliation:
Bambino Gesù Pediatric Hospital, Mediterranean Pediatric Cardiology Center, Taormina, Messina, Italy
Salvatore Agati
Affiliation:
Bambino Gesù Pediatric Hospital, Mediterranean Pediatric Cardiology Center, Taormina, Messina, Italy
Concetta Zito
Affiliation:
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Fiore S. Iorio
Affiliation:
Bambino Gesù Pediatric Hospital, Medical and Surgical Department of Pediatric Cardiology, Rome, Italy
Scipione Carerj
Affiliation:
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Paolo Guccione
Affiliation:
Bambino Gesù Pediatric Hospital, Medical and Surgical Department of Pediatric Cardiology, Rome, Italy
*
Correspondence to: L. Oreto, MD, Department of Clinical and Experimental Medicine, Cardiology, University Hospital, Via Consolare Valeria 100, Messina 98100, Italy. Tel: +39 090 2212 969; Fax: +390909572363; E-mail: liliaoreto@hotmail.com

Abstract

Aims

The aim of this study was to describe atrial septal defect morphology in hypoplastic left heart syndrome, to report the incidence of restrictiveness and its relationship with defect morphology, to correlate restriction with midterm outcome, and to describe our interventional approach to restrictive defect.

Methods and results

From 2011 to 2015, 31 neonates with hypoplastic left heart syndrome underwent hybrid procedure with pulmonary artery banding and ductal stenting at our Institution. Restrictive physiology of the atrial septal defect was based on Doppler gradient >6 mmHg through the defect and on clinical signs of pulmonary hypertension. The mean gradient was then measured invasively. Restrictive defect occurred in 11/27 patients (40%). The restrictive group showed three ostium secundum defects (27%) and eight complex morphologies (73%). Conversely, in the non-restrictive group, we observed 11 ostium secundum defects (69%) and five complex morphologies (31%). Early balloon atrioseptostomy was required in three cases. Late restriction occurred in eight patients and was dealt with balloon dilation, stenting, or atrioseptectomy. There was no significant difference between restrictive and non-restrictive groups in terms of early or 12-month survival.

Conclusions

Complex morphologies were more frequently related to restrictiveness. Stenting technique has a crucial role, as the procedure carries a significant risk for stent migration. Effective treatment of restrictive atrial septal defect is related to a better outcome, as it leads to equalisation of survival between patients with and those without restrictive atrial septal defect.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

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