STENTING OF THE ARTERIAL DUCT COMBINED WITH BANDING OF THE PULMONARY-ARTERIES AND ATRIAL SEPTECTOMY OR SEPTOSTOMY - A NEW APPROACH TO PALLIATION FOR THE HYPOPLASTIC LEFT-HEART SYNDROME

Objective-To assess the feasibility of pulmonary artery banding, atria l septectomy or septostomy, and percutaneous stenting of the arterial duct in babies with the hypoplastic left heart syndrome. Patients-Four infants with hypoplastic left heart syndrome. Setting-Two supraregion al paediatric cardiac centres. Methods-Ductal patency was maintained i nitially with prostaglandin E. Banding of the proximal branch pulmonar y arteries was performed through a median sternotomy and open atrial s eptectomy was performed if balloon septostomy was not. Stainless steel stents (Johnson & Johnson) mounted in a balloon catheter were implant ed into the arterial duct under radiographic control and expanded to a diameter of approximately 8 mm, prostaglandin treatment was then stop ped. Results-All the patients survived the immediate postoperative per iod and maintenance of wide ductal patency was achieved in three of th e four patients by stent implantation. Two weeks after the procedure t wo babies died of right ventricular failure and respiratory infection: some distal ductal constriction had occurred in one where the stent w as not quite sufficiently distally placed. One child was discharged ho me 15 days after treatment and was well at follow up at age 16 weeks a nd one was stable but required diuretic therapy five weeks after the p rocedure. Conclusions-This new approach is technically feasible. At le ast in the short term it seems to offer hope of effective palliation f or the hypoplastic left heart syndrome and it warrants further study.