Five Year Experience of Delivering Prenatally-Diagnosed Infants with Hypoplastic Left Heart Syndrome with Intact Atrial Septum in the Cardiac Catheterization Suite

  • Shyam Sathanandam, Hope Children Hospital, Oak Lawn, IL, United States
  • Andrew Van Bergen, Hope Children Hospital, Oak Lawn, IL, United States
  • David Roberson, Hope Children Hospital, Oak Lawn, IL, United States
  • Dhaval Patel, Hope Children Hospital, Oak Lawn, IL, United States
  • Tarek Husayni, Hope Children Hospital, Oak Lawn, IL, United States
  • Bettina Cuneo, Hope Children Hospital, Oak Lawn, IL, United States
  • Michel Ilbawi, Hope Children Hospital, Oak Lawn, IL, United States
  • Alexander Javois, Hope Children Hospital, Oak Lawn, IL, United States

    • Objective:
    The objective was to review our five year experience of utilizing the cardiac catheterization suite for cesarean section (C-section) delivery and immediate catheter intervention to create adequate interatrial communication (IAC) for infants with prenatal diagnosis of hypoplastic left heart syndrome (HLHS) with intact atrial septum (IAS) or severely restrictive IAC (SR-IAC).


    Methods:
    The period of study was January 2003 - December 2008. Group 1 included 117 infants with HLHS with adequate IAC. Group 2 included 7 infants with prenatal diagnosis of HLHS with IAS or SR-IAC delivered in the catheterization suite with immediate transcatheter intervention. Group 3 included 7 undiagnosed infants with SR-IAC who either underwent delayed intervention or no intervention before stage1 palliation.


    Results:
    Incidence of HLHS with IAS or SR-IAC during the study period was 14 of 131 (10.7%). Overall survival to stage 2 was 68% (Group 1), 43% (Group 2) and 0% (Group 3). Of the 7 infants in Group 2, two have completed stage3 palliation. In Group 3, four of seven infants were discharged after Norwood, but had interstage deaths. Statistical analysis revealed that survival differences between Groups 1 and 2 were due to chance. Survival benefits were observed both clinically and statistically between Groups 2 and 3.


    Conclusion:
    Using a multidisciplinary approach, time-saving measures can be instituted by delivering prenatally-diagnosed infants with HLHS with IAS via C-section in the cardiac catheterization suite where left atrial decompression can be performed quickly and safely. Our five year institutional experience proves that immediate intervention may improve survival.