Modified Microvascular Plug as a Flow Restrictor in Hypoplastic Left Heart Syndrome with Dysplastic Tricuspid and Pulmonary Valves.

Autor: Kurtz JD; Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville, 571 South Floyd Street, Ste. 113, Louisville, KY, 40202, USA. Joshua.Kurtz@louisville.edu.; Norton Children's Heart Institute, 411 E. Chestnut St. Ste. 544, Louisville, KY, 40202, USA. Joshua.Kurtz@louisville.edu., Alsoufi B; Norton Children's Heart Institute, 411 E. Chestnut St. Ste. 544, Louisville, KY, 40202, USA.; Department of Cardiovascular and Thoracic Surgery, University of Louisville, 201 Abraham Flexner Way, Ste. 1200, Louisville, KY, 40202, USA., Wilkens SJ; Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville, 571 South Floyd Street, Ste. 113, Louisville, KY, 40202, USA.; Norton Children's Heart Institute, 411 E. Chestnut St. Ste. 544, Louisville, KY, 40202, USA., Kim E; Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville, 571 South Floyd Street, Ste. 113, Louisville, KY, 40202, USA.; Norton Children's Heart Institute, 411 E. Chestnut St. Ste. 544, Louisville, KY, 40202, USA.
Jazyk: angličtina
Zdroj: Pediatric cardiology [Pediatr Cardiol] 2021 Oct; Vol. 42 (7), pp. 1653-1657. Date of Electronic Publication: 2021 Aug 07.
DOI: 10.1007/s00246-021-02701-2
Abstrakt: While the Norwood operation is the most common palliative surgery for neonates with hypoplastic left heart syndrome (HLHS), initial hybrid strategy aiming to restrict pulmonary blood flow and maintain systemic output is necessary when Norwood is contraindicated or at high risk. The traditional mainstay of initial hybrid palliation is surgical pulmonary artery branch banding (PABB) plus interventional ductal stenting. We present a case of a transcatheter approach for pulmonary flow restriction (PFR) that was accomplished by modifying a Medtronic microvascular plug (MVP)™. The patient is a 2.4 kg neonate diagnosed with HLHS, dysplastic tricuspid and pulmonary valves with pulmonary stenosis, tricuspid stenosis, and regurgitation. He was not considered a candidate for surgical intervention. He started developing sequelae of unbalanced pulmonary and systemic blood flow; therefore, he underwent placement of transcatheter PFR as alternative to PABB. He underwent successful orthotopic heart transplant 104 days after index procedure. This case demonstrates the significant complexity that can occur in patients with HLHS and abnormal right sided valves. Additionally, it is another example that transcatheter branch pulmonary artery flow restriction can be a safe and feasible alternative to PABB as initial palliation strategy. It may benefit patients in whom primary Norwood procedure would have increased risks or who will undergo primary transplant.
(© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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