Related Experiment Video
Updated: Jun 25, 2026
A Swine Model of Neonatal Asphyxia
Published on: October 11, 2011
Rethinking Neonatal Surgical Urgency: Effective Delay With Internal Flow Restrictors
Lindsey M Reynolds1, Seth E M Wolf2, Rebekah R Boyd3
1Duke University School of Medicine, Durham, North Carolina; Duke Congenital Heart Surgery Research and Training Laboratory, Durham, North Carolina.
Insights
Percutaneous pulmonary flow restrictors effectively manage pulmonary overcirculation in high-risk neonates, bridging them to surgical decisions. This adjustable strategy improves physiologic stability and supports weight gain before definitive treatment.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Neonatology
Background:
- Neonates with complex congenital heart disease often experience pulmonary overcirculation.
- Early surgical intervention can be risky due to instability, prematurity, or comorbidities.
Purpose of the Study:
- To evaluate the efficacy of percutaneous pulmonary flow restrictors as a bridge-to-decision strategy in high-risk neonates.
- To assess the impact on hemodynamic parameters, physiologic stabilization, and subsequent management.
Main Methods:
- Retrospective review of 38 neonates and infants undergoing percutaneous pulmonary flow restrictor placement.
- Assessment of hemodynamic (pulmonary-to-systemic flow ratio) and laboratory (lactate, creatinine) parameters pre- and post-placement.
- Evaluation of outcomes including stabilization, weight gain, interventions, and complications.
Main Results:
- Flow restrictor placement significantly reduced pulmonary blood flow (median P/S ratio from 3.6 to 0.84).
- Rapid improvements in lactate and creatinine were observed.
- 82% proceeded to surgery, with a median weight gain of 370g; 13% required repeat intervention.
Conclusions:
- Percutaneous pulmonary flow restrictors are a feasible and adaptable strategy for temporizing pulmonary overcirculation in high-risk neonates.
- This approach supports physiologic optimization and allows for individualized flow modulation.
- It facilitates assessment of clinical trajectory and candidacy for definitive intervention.
Background:
Neonates with complex congenital heart disease frequently experience pulmonary overcirculation, but early surgical intervention may be poorly tolerated as a result of physiologic instability, prematurity, or comorbidities. Percutaneous internal pulmonary flow restrictors offer an adjustable strategy to modulate pulmonary blood flow as a bridge to decision in high-risk infants.
Methods:
A retrospective review was conducted of 38 neonates and infants undergoing percutaneous pulmonary flow restrictor placement at a single institution from March 2023 to August 2025. Hemodynamic (pulmonary-to-systemic flow ratio) and laboratory (creatinine, lactate) variables were assessed before and after placement of the flow restrictor. Outcomes included physiologic stabilization, subsequent management decisions, weight gain, repeat interventions, major device- or catheter-related complications, and postsurgical complications.
Results:
Flow restrictor placement reduced pulmonary blood flow, with median pulmonary-to-systemic flow ratio decreasing from 3.6 to 0.84 and with rapid improvement in lactate and creatinine values. Thirty-one patients (82%) proceeded to definitive surgical intervention at a median of 16 days, with a median weight gain of 370 g. Four patients (13%) required repeat intervention to achieve adequate physiologic stabilization. Overall cohort mortality was 24% (7 preoperative, 2 postoperative), with no preoperative deaths among the repeat intervention subgroup. Postoperative complications occurred in 19% (6 of 31) of surgical patients. Two major device-related complications occurred (2 of 38; 5%).
Conclusions:
Percutaneous pulmonary flow restrictors provide a feasible and adaptable bridge to decision strategy to temporize pulmonary overcirculation and support physiologic optimization in high-risk neonates. Iterative, patient-specific adjustment enables individualized flow modulation while clinical trajectory and candidacy for definitive intervention are assessed.