Neonates with large, space-occupying left ventricular (LV) tumours present with ductal dependent systemic circulation. Their management with total or subtotal resection or Norwood palliation have been associated with disappointing and often fatal outcome. We present our short-term follow-up of two such neonates after the hybrid procedure.

The two patients were diagnosed prenatally with large tumours occupying the majority of the LV. Both patients had moderate to severe mitral regurgitation and heart failure scores which improved on Digoxin. At birth, ductal patency with prostaglandin was deemed necessary because the following findings were noted by echocardiography: retrograde aortic arch flow, bidirectional ductal flow, reduced antegrade aortic flow, poor LV function (in one patient) and significant mitral regurgitation.

After stabilization with intravenous inotropes and diuretics, each patient underwent the Hybrid approach at one week of life. Following sternotomy self expandable 8 and 9mm stents were implanted into the ductus arteriosus following bilateral 3.5 mm branch pulmonary artery bands. One week later they underwent balloon atrial septostomy. At 5 months of age, both patients demonstrated almost total resolution of mitral regurgitation, improvement to normal systolic LV function and clinical resolution of heart failure symptoms. After repeat catheterization, they underwent surgical Norwood, removal of stent and Glenn shunt with satisfactory results. Both patients are thriving well at 15 and 16 months of age.

We conclude that the hybrid approach followed by staged cavo-pulmonary avastomosis is feasible and an effective alternative in the management of neonates with large LV tumours