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Initial Experience With Transcatheter Pulmonary Artery Flow Restriction In Neonates With Complex Cyanotic Heart Disease
L. Mac Felmly, MD, Jason R. Buckley, MD, Varsha M. Bandisode, MD, Minoo N. Kavarana, MD.
Medical University of South Carolina, Charleston, SC, USA.
Objective(s): Initial palliation of complex neonatal heart disease with bilateral pulmonary artery banding is suboptimal, as it necessitates an additional sternotomy and can induce pulmonary artery stenoses. Our program investigated the suitability of transcatheter pulmonary artery flow restriction as an alternative.
Methods: This study is a single center retrospective review of neonates who underwent transcatheter placement of intravascular pulmonary artery flow restrictors (PAFR) ahead of surgical repair. Flow restrictors were fashioned by modifying an existing microvascular plug (Medtronic, MN, USA).
Results: Eight patients underwent PAFR placement at a median age of 6 days (2-23). Five were term and three were late pre-term. Mean birth weight was 2.99+/-0.45 kg. Four had anatomy necessitating a single ventricle strategy and four had biventricular anatomy. There were no procedural complications. All patients were able to extubate after PAFR and tolerate enteral feeds. Five patients have undergone surgical correction, at a median age of 51 days. Mean weight at the time of surgery was 3.70+/-0.21 kg for a mean preoperative weight gain of 819 grams. Three underwent Norwood, one truncus repair, and one truncus and interrupted arch repair. Median postoperative length of stay was 27 days. There was one postoperative mortality in an infant who suffered from restrictive atrial septal physiology, lymphangiectasia, and refractory chylothorax.
Conclusions: Transcatheter PAFR placement is a safe and effective method of controlling pulmonary artery blood in the setting of complex neonatal congenital heart disease to allow growth and maturation before surgical repair.
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