Percutaneous transhepatic stenting of a restrictive atrial septal communication in hypoplastic left heart syndrome
Khalfan Al Senaidi1, Abdulrahman Al Mesned, James Y Coe
1Division of Pediatric Cardiology, Sultan Qaboos University, Sultanate of Oman.
Insights
Successful transhepatic venous stenting of a restrictive atrial septal defect in an infant with hypoplastic left heart syndrome (HLHS) provided a vital alternative access route for cardiac catheterization interventions.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Postnatal survival in infants with hypoplastic left heart syndrome (HLHS) relies on ductus arteriosus patency and an unrestrictive atrial septal defect (ASD).
- Restrictive ASDs can compromise pulmonary and systemic blood flow, necessitating intervention.
Observation:
- A six-week-old infant presented with HLHS, tricuspid valve regurgitation, and a restrictive ASD.
- Initial attempts at transfemoral balloon atrial septostomy provided only temporary relief and were not repeatable.
Findings:
- A transhepatic venous approach was successfully employed to stent the restrictive atrial communication.
- This technique allowed for the use of a large delivery system (≥ 8 Fr), crucial for complex interventions.
Implications:
- The transhepatic venous approach offers a viable alternative access route for infant cardiac catheterization when traditional methods fail.
- This technique expands interventional options for neonates and infants with complex congenital heart defects requiring large-bore access.
Abstract:
The postnatal survival of patients with congenital cardiac defects such as hypoplastic left heart syndrome (HLHS) is dependent on the patency of the ductus arteriosus and the presence of an unrestrictive atrial septal defect (ASD). We report a six week old infant with HLHS and tricuspid valve regurgitation with restrictive ASD. Transfemoral balloon atrial septostomy provided temporary relief but further attempts were not possible. A transhepatic venous approach to stent the atrial communication was technically successful. This approach may be the only access for certain infant cardiac catheterization interventions, permitting the use of a large delivery system (≥ 8 Fr).
