Management of Neonates With Complex Left-Sided Obstructions Using Endovascular Flow Regulators and Ductal Stenting

Surgical repair or palliation in neonates with complex left-sided obstructive congenital heart disease, especially with comorbidities or low birth weight, remains a high-risk intervention. We describe an initial transcatheter strategy involving the implantation of modified pulmonary vascular occluders and stenting of the ductus arteriosus to regulate pulmonary overflow and maintain systemic perfusion. Four neonates are presented: 2 low-birth-weight neonates with hypoplastic left heart syndrome and left ventricular-to-coronary artery connections; one significantly underweight neonate with aortic arch hypoplasia, aortic stenosis, and patent ductus arteriosus; and another with interrupted aortic arch, double right ventricular outflow tract, and transposition of the great arteries. All were considered high risk for immediate surgical correction. This endovascular approach provided hemodynamic stability during the neonatal period, allowing for clinical improvement and weight gain before definitive surgical management. These findings suggest a promising alternative for selected critically ill neonates with complex cardiac anatomy.