The role of interventional cardiology in pediatric heart transplantation

Hypoplastic left heart syndrome (HLHS) is the most common cause of cardiac death during the first week of life. The prognosis of this fatal malformation has changed completely since the introduction of neonatal heart transplantation. However, patients awaiting a heart donor are at high risk for closure of the ductus arteriosus and are exposed to complications from indwelling central venous catheters and long-term use of prostaglandin E1. To maintain the ductal patency, which is crucial for the survival of these patients, we performed a stenting of the ductus arteriosus in six infants with HLHS using a 2 cm length balloon expendable stent. Age ranged from 5 to 92 days and weight ranged from 2.1 to 5.4 kg. Successful stenting with subsequent hemodynamic stability was obtained in all the patients. Patient 4 died 24 hours after stenting from hemothorax related to an attempted subclavian catheter placement. Heart transplantation was successfully performed in patients 1, 2, 3, and 5 at 15, 1, 50, and 8 days after stenting, respectively. Patient 6 underwent successful heart transplantation 157 days after ductal stenting.