Preoperative management of pulmonary venous hypertension in hypoplastic left heart syndrome with restrictive atrial septal defect

A severely restrictive atrial septal defect (ASD) in neonates with hypoplastic left heart syndrome (HLHS) results in pulmonary venous hypertension, pulmonary edema, and intractable hypoxia. Between January 1983 and June 1998, 21 of 355 neonates presenting with HLHS (5.9%) underwent cardiac catheteri...

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Bibliographic Details
Published in:The American journal of cardiology 1999-04, Vol.83 (8), p.1224-1228
Main Authors: Atz, Andrew M, Feinstein, Jeffrey A, Jonas, Richard A, Perry, Stanton B, Wessel, David L
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cardiac Catheterization
Cardiology
Cardiology. Vascular system
Cardiovascular disease
Cineangiography
Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava
Follow-Up Studies
Health care
Heart
Heart Septal Defects, Atrial - complications
Heart Septal Defects, Atrial - diagnostic imaging
Heart Septal Defects, Atrial - surgery
Heart Transplantation
Humans
Hypertension
Hypertension, Pulmonary - diagnostic imaging
Hypertension, Pulmonary - etiology
Hypertension, Pulmonary - therapy
Hypoplastic Left Heart Syndrome - complications
Hypoplastic Left Heart Syndrome - diagnostic imaging
Hypoplastic Left Heart Syndrome - surgery
Infant, Newborn
Medical procedures
Medical sciences
Preoperative Care - methods
Radiography, Thoracic
Retrospective Studies
Treatment Outcome
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Description
Summary:A severely restrictive atrial septal defect (ASD) in neonates with hypoplastic left heart syndrome (HLHS) results in pulmonary venous hypertension, pulmonary edema, and intractable hypoxia. Between January 1983 and June 1998, 21 of 355 neonates presenting with HLHS (5.9%) underwent cardiac catheterization at median age 1 day (range 0 to 25), for creation or enlargement of a restrictive or absent interatrial communication. One patient died during preliminary angiography. Three underwent blade septostomy with 2 procedure-related deaths, and 1 had balloon atrial septostomy (BAS); all 4 died before surgical intervention. Fifteen underwent Brockenbrough atrial septoplasty with transatrial needle puncture and serial balloon dilations of the new ASD, 5 after unsuccessful BAS. The most recent patient had a stent placed across the atrial septum after transatrial needle puncture. In the 16 patients treated with septoplasty or stent, oxygen saturation increased from 50 ± 4% to 83 ± 2% (p
ISSN:0002-9149
1879-1913
DOI:10.1016/S0002-9149(99)00087-9