Abstract 19571: Atrial Septal Interventions After Ductal Stenting and Bilateral Pulmonary Artery Banding

Abstract

Introduction Bilateral pulmonary artery banding with arterial duct stenting (H1) leaves the state of the atrial septum unresolved. Atrial communications can become restrictive and their management is an important problem. We reviewed our experience of atrial septal interventions (ASI) in H1 patients until their second stage procedure (H2). Methods and Results A retrospective analysis of the first 66 H1 patients between 2004 and 2011. Thirty-nine (59%) of these patients had hypoplastic left heart syndrome. 34/66 (52%) patients required 42 ASI. These were performed before (n=4), during (n=5) or after H1 (n=25). An ASI was frequently required for neonates on a path to a Fontan (29/48, 60%) or being bridged to transplantation (4/10, 40%), but was rare for borderline LV (1/8, 13%). An ASI was required if there was a small ASD on the initial echocardiogram (p<0.01). A variety of percutaneous techniques were used: balloon septostomy/septoplasty (including cutting balloons), stenting and radio-frequency perforation of the atrial septum. Directly measured trans-septal mean gradient decreased from 12mmHg (range 2-25 mmHg) to 1mmHg (range 0-10mmHg). There were three ASI related deaths and 6 major complications. Three patients with LV sinusoids/fistulae experienced acute myocardial ischaemia following ASI. ASI was associated with an increased risk of death prior to H2. Conclusion Catheter techniques can produce minimally restrictive atrial communications, but can be associated with post-procedural instability. In patients with coronary sinusoids, myocardial ischaemia may occur if there is a large increase in pulmonary blood flow.