Aim: To define the contribution of catheter interventions in the management of patients with HLHS.
Methods: Retrospective case note review of all 505 patients with HLHS, undergoing Norwood palliation over a 15 year period (1993-2008).
Results: 505 patients with HLHS were treated. A total of 268 catheter interventions were performed in 168 patients. Two patients underwent initial hybrid Stage I procedure.
Pre- Norwood Stage 1 interventions: 5 patients underwent emergency balloon atrial septostomy (1%).
Pre-Cavopulmonary Shunt (93 interventions in 85/336 patients -25%): 69 pts underwent balloon angioplasty of re-coarctation (20.5%), and 10 had stenting of a RV-PA conduit (1 bail-out). Six patients had other procedures (balloon / stent of veins or atrial septum)
Pre-Fontan Completion (106 interventions in 74/285 patients -26%): 26 LPA angioplasty, 28 LPA stenting, 22 occlusion of veno-venous collaterals and 20 coarctation angioplasties were performed. A further 10 other procedures were performed (balloon / stent of veins or atrial septum, EPS)
Post Fontan Completion (60 interventions in 43/280 patients-15%): 16 Fontan fenestration closures, 14 stenting of Fontan fenestration and 10 LPA balloons, 16 LPA stents, and 4 others. Coarctation balloon angioplasty was effective in all with freedom from reintervention in 59/73 pts (81%). LPA angioplasty was of only limited benefit (freedom from reintervention in 14/36 (39%), making LPA stenting the preferred technique. There were 1/44 (2.3%) late occlusion after LPA stent.
Conclusion: Interventional cardiac catheterization constitutes an integral part in the management of patients with HLHS.