Left heart hypoplasia operated using double pulmonary arterial banding with double arterial duct stenting: A case report

Dragomir,Cristina; Manea,Aniko-Maria; Enatescu,Virgil Radu; Lacatusu,Alina Adriana Mara; Lacatusu,Adrian; Henry,Osakwe Ifeanyi; Boia,Marioara; Ilie,Constantin

doi:10.3892/etm.2020.9323

Left heart hypoplasia operated using double pulmonary arterial banding with double arterial duct stenting: A case report

Authors:
- Cristina Dragomir
- Aniko-Maria Manea
- Virgil Radu Enatescu
- Alina Adriana Mara Lacatusu
- Adrian Lacatusu
- Osakwe Ifeanyi Henry
- Marioara Boia
- Constantin Ilie
View Affiliations

Affiliations: Obstetrics‑Gynaecology (Ⅻ) Department, Discipline of Neonatology and Childcare, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania, Neuroscience (Ⅷ) Department, Discipline of Psychiatry, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania, ‘Bega’ Pediatric II Clinic, ‘Pius Brinzeu’ County Emergency Clinical Hospital, 300226 Timisoara, Romania, Pediatric Surgery and Orthopedics Department, Arad County Emergency Clinical Hospital, 310158 Arad, Romania
Published online on: October 14, 2020 https://doi.org/10.3892/etm.2020.9323
Article Number: 193

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Hypoplastic left heart syndrome is a heterogeneous group of congenital cardiac malformations which associates hypoplastic/aplastic left ventricle, mitral and aortic valve, hypoplastic/atresia and severe aortic artery coarctation, and represents a medical‑surgical emergency. We present a case of a newborn hospitalised in three clinics (two clinics from Timisoara and one from Vienna), and operated for hypoplastic left heart syndrome, without aortic coarctation, using a mixed technique cardiovascular repair surgery. The initial therapeutic conduct included maintaining the permeability of the arterial canal with prostaglandin E1. At the Vienna General Hospital, at the age of 17 days, bilateral banding of the pulmonary artery was performed and, at the age of 20 days, during the cardiac catheterisation, the Rashkind procedure (balloon atrial septostomy) was performed, with two stents being implanted in the arterial canal. Postoperative complications were postcardiotomy syndrome, pneumonia with Enterococcus faecalis and Stenotrophomonas maltophilia, sepsis with methicillin‑resistant Staphylococcus aureus, coagulopathy, mixed anaemia, and metabolic acidosis. The patient died 1 month after the intervention due to cardiorespiratory arrest, bilateral congestive heart failure, left heart hypoplasia with shunt through the arterial canal and pulmonary artery banding, multiorgan failure, and severe secondary haemorrhagic disease. In conclusion, the initial cardiac surgical reconstruction consisted of a mixed technique, and anticoagulant medical treatment with heparin, antibiotics (bacterial endocarditis prophylaxis to be performed throughout life); postintervention hypoxic and infectious complications resulted in multiorgan failure and death.

View Figures

View References

1	Si MS, Hirsch-Romano JC, Bove EL, Ohye RG, Windle ML, Mancini MC, Berge S and Odim J: Surgical treatment of pediatric hypoplastic left heart syndrome Medscape, 2014. urihttp://emedicine.medscape.com/article/904137-overviewsimplehttp://emedicine.medscape.com/article/904137-overview. Accessed April 11, 2014.
2	Si MS, Bove EL, Romano JC and Ohye RG: How I teach the Norwood procedure. Ann Thorac Surg. 101:2045–2048. 2016.PubMed/NCBI View Article : Google Scholar
3	Cloherty J, Eichenwad E and Stark A: Manual of neonatal care. 7th edition. Lippincott Williams & Wilkins, Philadelphia, PA, 2017.
4	Gardner S, Carter B, Enzman-Hines M and Hernandez J: Merenstein and Gardner's Handbook of neonatal intensive care. 8th edition. Elsevier Inc., St. Louis, MO, 2016.
5	Sakurai T, Rogers V, Stickley J, Khan N, Jones TJ, Barron DJ and Brawn WJ: Single-center experience of arch reconstruction in the setting of Norwood operation. Ann Thorac Surg. 94:1534–1539. 2012.PubMed/NCBI View Article : Google Scholar
6	Anderson R, Pozzi M and Hutchinson S: Hypoplastic left heart syndrome. Springer-Verlag, London, 2005.
7	Alabdulgader AA: Survival analysis: Outcome of prenatal versus postnatal diagnosis of hypoplastic left heart syndrome. J Invasive Cardiol. 1:8–12. 2018.
8	Roeleveld PP, Axelrod DM, Klugman D, Jones MB, Chanani NK, Rossano JW and Costello JM: Hypoplastic left heart syndrome: From fetus to Fontan. Cardiol Young. 28:1275–1288. 2018.PubMed/NCBI View Article : Google Scholar
9	Beer M and Berkow R: The Merck manual of diagnosis and therapy, 18th edition. Merck, 2006.
10	Connor JA and Thiagarajan R: Hypoplastic left heart syndrome. Orphanet J Rare Dis. 2(23)2007.PubMed/NCBI View Article : Google Scholar
11	Freedom R, Benson L and Smallhorn J: Neonatal heart disease. 1st edition. Springer-Verlag, London, 1991.
12	Johnson S: Hypoplastic left heart syndrome. Healthline Media, San Francisco, CA, 2016. urihttps://www.healthline.com/health/hypoplastic-left-heart-syndromesimplehttps://www.healthline.com/health/hypoplastic-left-heart-syndrome. Updated March 30, 2017.
13	Riddick-Grisham S: Pediatric life care planning and case management. Vol 3. 2nd edition. CRC Press LLC, Boca Raton, FL, 2011.
14	Erek E, Yylmaz B, Kaya M, Onan YS, Þen O, Oz K, Koçyigit ÖI, Güzeltaş A and Ödemiş E: Analysis of results according to the Aristotle scoring system in congenital heart surgery. Turkish J Thoracic Cardiovascular Surg. 22:509–516. 2014.
15	Kliegman R, Stanton B, Geme J and Schor N: Nelson Textbook of pediatrics. Vol 2. 20th edition. Elsevier Inc., 2016.
16	Wilder T, Hickey E, Ziemer G, Jacobs M, Gruber P, Blackstone E, McCrindle B, Williams W, DeCampli W, Caldarone AC and Pizarro C: Hybrid Alternatives to Norwood Stage-1 are not a lower risk alternative: Norwood-RVPA offers better outcome in comparable neonates. Circulation. 130(19493)2018.