Objective: Stage I palliation of hypoplastic left heart syndrome (HLHS) is morbid in developing countries. A less invasive hybrid approach was adopted in a low birth weight baby.
Methods: HLHS was diagnosed in one of twin delivered with birth weight of 2.2 kg. Echocardiogram showed aortic atresia, restrictive foramen ovale, adequate right ventricular and tricuspid valve function. After ProstaglandinE1 (PGE1) and dopamine infusions for 5 days, bilateral pulmonary artery banding to 3 mm was done through sternotomy while ventilating in 21% oxygen. After a pursestring supported insertion of a 6 French introducer sheath through the main pulmonary artery, angiogram was done in lateral view with cranial angulation. The entire duct length was stented with 8mm balloon expandable stent. The retrograde aortic arch flows were uninterupted. After stent placement, the PGE1 infusion was stopped. Adequate Rashkind balloon atrial septostomy was done through a right femoral venous access.
Results: Systemic pressures stabilised after bilateral pulmonary artery banding and ductal stent. Baby was extubated in less than 24 hours, and given oral aspirin. On two month follow up, the baby weighed 4.1 kg, there was a 15 mmHg gradient across the distal end of ductal stent, which was dilated during a cardiac catheterization done at 75 days. The baby awaits second stage Norwood procedure. At the last follow up right ventricular and tricuspid valve function are good.
Conclusion: Stage I hybrid management of HLHS offers a less morbid and more predictable approach than conventional Norwood especially in the developing world.