Bilateral pulmonary artery banding in higher risk neonates with hypoplastic left heart syndrome.

Objectives: Limited data on performing bilateral pulmonary artery banding (BPAB) before stage 1 Norwood procedure suggest that some patients may benefit through the postponement of the major cardiopulmonary bypass procedure. The objective of this study was to evaluate the effectiveness of BPAB in the surgical management of high-risk patients with hypoplastic left heart syndrome (HLHS). Methods: A retrospective review of all high-risk neonates with HLHS who underwent BPAB at our institution was performed. No patients, including those with intact or highly restrictive atrial septum (IAS), were excluded. Results: Between October 2015 and April 2021, 49 neonates with HLHS (including 6 with IAS) underwent BPAB, 40 of whom progressed to the Norwood procedure. Risk factors for not progressing to the Norwood procedure after BPAP include low birth weight (P = .043), the presence of multiple extracardiac anomalies (P = .005), and the presence of genetic disorders (P = .028). Operative mortality was 7.5% (3/40). IAS was associated with operative mortality (P = .022). Conclusions: The strategy of BPAB prestage 1 Norwood procedure was successful in identifying at-risk patients and improving Norwood survival. Although not all patients will need this hybrid approach, a significant number can be expected to benefit from this tactic. These results support the need for a substantial hybrid strategy, in addition to a primary stage 1 Norwood surgical strategy, in the management of HLHS.

Isolated ostial left main coronary artery stenosis causing ischemic cardiomyopathy in a child with bicuspid aortic valve: Role of echocardiography in diagnosis and follow-up.

Bicuspid aortic valve (BAV) is the most common congenital cardiac defect, commonly associated with valve dysfunction and coarctation of aorta. Rarely, BAV can be associated with abnormalities of the coronary arteries, the most common of which are ectopic coronary origins. In this report, we present a case of a 2-year-old child with BAV, without coexisting supravalvular aortic stenosis, who was found to have a left main coronary ostio-proximal stenosis, leading to ischemic cardiomyopathy and congestive heart failure.

Spontaneous thrombus formation in native aortic root in patients with hypoplastic left heart syndrome: clinical presentation, treatment, and outcomes.

We report a neonate who presented with spontaneous thrombus formation in the native aortic root after Norwood palliation for hypoplastic left heart syndrome. Thrombus formation led to myocardial ischaemia due to decreased coronary blood flow with electrocardiographic signs of ischaemia and elevated cardiac enzymes. Aggressive thrombolysis and anticoagulation therapy were major contributors to successful outcome.

Pediatric Ureteral Stent Placement to Manage Right Kidney Hemorrhage Following Coarctation Angioplasty.

This is the first case report of a catastrophic renal bleeding into the renal collecting system causing hemorrhagic shock in a child after a cardiac catheterization. In this case report, we discuss how we used nontraditional means of endourologic intervention in treating our hemodynamically unstable patient resulting in saving the patient's life and kidney.

Percutaneous stent implantation into coronary arteries in infants.

OBJECTIVES: To investigate the feasibility, procedural techniques, safety, and overall potential of percutaneous coronary angioplasty and stent implantation in infants with coronary artery disease and acute coronary syndrome. BACKGROUND: Despite extensive experience in adult patients, percutaneous coronary intervention remains uncommon in children and extremely rare in infants. METHODS: Retrospective review including all children who underwent percutaneous coronary angioplasty in Rady Children's Hospital-San Diego during a period of 4 years. RESULTS: Seven children including four children less than 15 months of age underwent percutaneous coronary intervention with coronary stent implantation in the proximal portion of the left or right coronary arteries. Successful stent placement with excellent revascularization was achieved in all cases. Mean coronary artery diameter was 0.65 mm prior to stent placement. Balloon angioplasty resulted in suboptimal resolution of coronary stenosis, thus bare metal stents were implanted in all cases, dilated to a mean of 2.5-mm internal diameter. Average intervention-free period was 434 days after stent implantation. In-stent re-stenosis and stent thrombosis did not occur if the implanted stent diameter was greater than 2.5 mm and the patient received dual anti-platelet therapy. CONCLUSIONS: Our experience suggests that coronary artery stent implantation is a feasible and relatively safe palliative option in infants and toddlers with coronary stenosis. It is a viable strategy for bridging patients with acute ischemia or poor ventricular function to elective surgical revascularization or transplantation.