Transcatheter Pulmonary Flow Restrictors as a Palliative Bridge to Heart Transplant

Area of Science:

• Neonatal Cardiology
• Interventional Cardiology
• Pediatric Cardiac Surgery

Background:

• Critical aortic stenosis (AS) in neonates presents significant challenges, often requiring complex management strategies.
• Surgical pulmonary artery banding is a traditional method for managing pulmonary over-circulation, but transcatheter alternatives are emerging.

Observation:

• A term male neonate with critical AS and severely reduced left ventricular systolic function underwent initial aortic balloon valvuloplasty with limited improvement.
• Pulmonary over-circulation and systemic steal developed, necessitating further intervention.
• A transcatheter stage 1 procedure involved bilateral pulmonary flow restrictor (PFR) devices and ductal stenting.

Findings:

• The transcatheter PFR placement successfully restricted pulmonary arterial flow, improving clinical status and facilitating weaning from respiratory support.
• The infant was successfully bridged to heart transplantation with excellent recovery and graft function 3 years post-procedure.

Implications:

• Transcatheter PFRs represent an effective strategy for stabilizing neonates with critical AS and pulmonary over-circulation.
• This approach provides a viable bridge to heart transplantation, offering a less invasive alternative to surgical banding.
• Pulmonary flow restriction via transcatheter PFRs holds potential for other neonatal conditions requiring precise control of pulmonary blood flow.