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Castaldi B, Cuppini E, Fumanelli J, Di Candia A, Sabatino J, Sirico D, Vida V, Padalino M, Di Salvo G. Chronic Heart Failure in Children: State of the Art and New Perspectives. J Clin Med 2023; 12:2611. [PMID: 37048694 PMCID: PMC10095364 DOI: 10.3390/jcm12072611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
Pediatric heart failure (HF) is an important clinical condition with high morbidity and mortality. Compared to adults, pediatric HF shows different etiologies characterized by different physiology, a different clinical course, and deeply different therapeutic approaches. In the last few years, new drugs have been developed and new therapeutic strategies have been proposed with the goal of identifying an individualized treatment regimen. The aim of this article is to review the new potential drugs and non-pharmacological therapies for pediatric heart failure in children.
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Affiliation(s)
- Biagio Castaldi
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Elena Cuppini
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Jennifer Fumanelli
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Angela Di Candia
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
| | - Jolanda Sabatino
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
| | - Domenico Sirico
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
| | - Vladimiro Vida
- Pediatric Cardiac Surgery Unit, Department of Cardio Thoracic Sciences, University of Padua, 35122 Padova, Italy
| | - Massimo Padalino
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
- Pediatric Cardiac Surgery Unit, Department of Cardio Thoracic Sciences, University of Padua, 35122 Padova, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Women’s and Children’s Health, University of Padua, 35122 Padova, Italy
- Pediatric Research Institute (IRP) Città della Speranza, University of Padua, 35122 Padova, Italy
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Paitazoglou C, Bergmann MW. The atrial flow regulator: current overview on technique and first experience. Ther Adv Cardiovasc Dis 2021; 14:1753944720919577. [PMID: 32972299 PMCID: PMC7522821 DOI: 10.1177/1753944720919577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Martin W Bergmann
- Interventional Cardiology, Cardiologicum Hamburg, Schloßgarten 3-7, Hamburg 22401, Germany
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3
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Transesophageal echocardiography in the pediatric interventional cardiac catheterization laboratory. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cuthbert JJ, Pellicori P, Clark AL. Interatrial shunt devices for heart failure with normal ejection fraction: a technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:123-132. [PMID: 28652826 PMCID: PMC5476655 DOI: 10.2147/mder.s113105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Heart failure with normal ejection fraction (HeFNEF) accounts for ~50% of heart failure admissions. Its pathophysiology and diagnostic criteria are yet to be defined clearly which may hinder the search for effective treatments. The clinical hallmark of HeFNEF is exertional breathlessness, often due to an abnormal increase in left atrial pressure during exercise. Creation of an interatrial communication to offload the left atrium is a possible therapeutic approach. There are two percutaneously delivered devices currently under investigation which are discussed in this review.
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Affiliation(s)
- Joseph J Cuthbert
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
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Off-Pump Atrial Septectomy for Infants With Restrictive Atrial Septal Defect. Ann Thorac Surg 2016; 103:e111-e113. [PMID: 28007262 DOI: 10.1016/j.athoracsur.2016.07.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 11/20/2022]
Abstract
The management of some subsets of patients with an unsuccessful balloon atrial septostomy (BAS) and poor general condition is typically challenging. Our novel technique involves off-pump atrial septectomy using laparoscopic forceps guided by intraoperative direct pericardial echocardiography. The technique was first used in a case of tricuspid atresia in a patient in preshock and was then used in 2 more patients with hypoplastic left heart syndrome (HLHS) (age, 10-116 days; body weight, 2.4-3.7 kg). There were no operative complications of embolism or bleeding in our series. Our off-pump atrial septectomy technique is an effective approach in specific cases.
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Seghaye MC. Management of children with congenital heart defect: state of the art and future prospects. Future Cardiol 2016; 13:65-79. [PMID: 27936920 DOI: 10.2217/fca-2016-0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The treatment of children with congenital heart defects has evolved in the last 60 years from conservative care to a highly specialized management where advances in imaging, surgical, interventional and support techniques meet together to ensure satisfactory development and good quality of life to the child and to the upcoming grown up. Management of congenital heart defects best begins before birth with the aim, whenever possible, to maintain or establish biventricular physiology or, if this is excluded, to optimize the conditions for univentricular physiology. Current research in the field of genetics, device bioengineering and miniaturization, stem cell therapy, and fusion imaging technology is expected to help to improve further patient outcome. In this review, current management strategies and future prospects are discussed.
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Affiliation(s)
- Marie-Christine Seghaye
- Department of Pediatrics-Pediatric Cardiology, University Hospital Liège, Rue de Gaillarmont 600, B. 4032 Liège, Belgium
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Abstract
A wide atrial communication is important to maintain hemodynamics in certain forms of congenital and acquired heart defects. In comparison to balloon septostomy or blade septostomy, atrial septal stenting provides a controlled, predictable, and long-lasting atrial communication. It often needs a prior Brockenbrough needle septal puncture to obtain a stable stent position. A stent deployed across a previously dilated and stretched oval foramen or tunnel form of oval foramen carries higher risk of embolization. This review provides technical tips to achieve a safe atrial septal stenting. Even though this is a “How to do it article,” an initial discussion about the indications for atrial septal stenting is vital as the resultant size of the atrial septal communication should be tailored for each indication.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, The Madras Medical Mission, Chennai, Tamil Nadu, India
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Benedict RR, Kumar A, Francis E, Kumar RK. Off-pump atrial septostomy with thoracoscopic scissors under transesophageal echocardiography guidance. Ann Pediatr Cardiol 2014; 6:170-2. [PMID: 24688238 PMCID: PMC3957450 DOI: 10.4103/0974-2069.115273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Selected children with congenital heart defects undergoing palliative closed heart procedures require a cardiopulmonary bypass (CPB) run only for the purpose of creating an inter-atrial communication. We report a simple technique of atrial septostomy using thoracoscopy scissors under transesophageal echocardiography guidance without the need for CPB.
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Affiliation(s)
- Raj R Benedict
- Department of Pediatric Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Anuj Kumar
- Department of Pediatric Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - Edwin Francis
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
| | - R Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India
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Catheter Intervention for Congenital Heart Disease at Risk of Circulatory Failure. Can J Cardiol 2013; 29:786-95. [DOI: 10.1016/j.cjca.2013.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 11/24/2022] Open
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Kutty S, Delaney JW, Latson LA, Danford DA. Can we talk? Reflections on effective communication between imager and interventionalist in congenital heart disease. J Am Soc Echocardiogr 2013; 26:813-27. [PMID: 23768692 DOI: 10.1016/j.echo.2013.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Indexed: 02/06/2023]
Abstract
The rapid proliferation of catheter-mediated treatments for congenital heart defects has brought with it a critical need for cooperation and communication among the numerous physicians supporting these new and complex procedures. New interdependencies between physicians in specialties including cardiac imaging, interventional cardiology, pediatric cardiology, anesthesia, cardiothoracic surgery, and radiology have become apparent, as centers have strived to develop the best systems to foster success. Best practices for congenital heart disease interventions mandate confident and timely input from an individual with excellent adjunctive imaging skills and a thorough understanding of the devices and procedures being used. The imager and interventionalist must share an understanding of what each offers for the procedure, use a common terminology and spatial orientation system, and convey concise and accurate information about what is needed, what is seen, and what cannot be seen. The goal of this article is to review how the cardiovascular imaging specialists and interventionalists can work together effectively to plan and execute catheter interventions for congenital heart disease.
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Affiliation(s)
- Shelby Kutty
- Division of Pediatric Cardiology, University of Nebraska Medical Center College of Medicine and Children's Hospital and Medical Center, Omaha, Nebraska, USA.
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Off-Pump Atrial Septal Defect Closure Using the Universal Cardiac Introducer ®. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009. [DOI: 10.1177/155698450900400105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Peters B, Ewert P, Berger F. The role of stents in the treatment of congenital heart disease: Current status and future perspectives. Ann Pediatr Cardiol 2009; 2:3-23. [PMID: 20300265 PMCID: PMC2840765 DOI: 10.4103/0974-2069.52802] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intravascular or intracardiac stenoses occur in many forms of congenital heart disease (CHD). Therefore, the implantation of stents has become an accepted interventional procedure for stenotic lesions in pediatric cardiology. Furthermore, stents are know to be used to exclude vessel aneurysm or to ensure patency of existing or newly created intracardiac communications. With the further refinement of the first generation of devices, a variety of "modern" stents with different design characteristics have evolved. Despite the tremendous technical improvement over the last 20 years, the "ideal stent" has not yet been developed. Therefore, the pediatric interventionalist has to decide which stent is suitable for each lesion. On this basis, currently available stents are discussed in regard to their advantages and disadvantages for common application in CHD. New concepts and designs developed to overcome some of the existing problems, like the failure of adaptation to somatic growth, are presented. Thus, in the future, biodegradable or growth stents might replace the currently used generation of stents. This might truly lead to widening indications for the use of stents in the treatment of CHD.
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Affiliation(s)
- Bjoern Peters
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany
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Off-Pump Atrial Septal Defect Closure Using the Universal Cardiac Introducer®. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009; 4:20-6. [DOI: 10.1097/imi.0b013e31819878f2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Optimal atrial septal defect (ASD) closure should combine off-pump techniques with the effectiveness and versatility of open-heart techniques. We report our experience with off-pump ASD closure using the Universal Cardiac Introducer (UCI) in a porcine model. The goal was to create an ASD over the fossa ovale (FO) and position a patch over the ASD under ultrasound (US) imaging and augmented virtual reality guidance. Methods An US probe (tracked with a magnetic tracking system) was positioned into the esophagus (transesophageal echocardiographic probe) for real-time image-guidance. The right atrium (RA) of six pigs was exposed via a right lateral thoracotomy or medial sternotomy. The UCI was attached to the RA wall. A punching tool was introduced via the UCI, navigated and positioned, under US guidance, to create an ASD into the FO. A patch with its holder and a stapling device were introduced into the RA via the UCI. The patch was positioned on the ASD. Occlusion of the ASD was determined using US and Doppler imaging. Results The FO membrane was excised successfully in all animals. US image-guidance provided excellent visualization. The patch was positioned in all cases with complete occlusion of the ASD. The stapling device proved too bulky, impeding circumferential positioning. Conclusions Using the UCI, ASD closure was safe and feasible. US imaging, combined with virtual and augmented reality provided accurate navigating and positioning. This study also provided valuable information on the future design of anchoring devices for intracardiac procedures.
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Pilla CB, Pedra CAC, Nogueira AJS, Jatene M, Souza LCB, Pedra SRF, Ferreiro C, Ricachinevsky CP, Lucchese FA. Hybrid management for hypoplastic left heart syndrome : an experience from Brazil. Pediatr Cardiol 2008; 29:498-506. [PMID: 18080154 DOI: 10.1007/s00246-007-9136-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Revised: 08/12/2007] [Accepted: 10/22/2007] [Indexed: 11/29/2022]
Abstract
Initial surgical reconstruction for hypoplastic left heart syndrome (HLHS) is associated with satisfactory outcomes only in a few referral centers. Moreover, there is a persistent high-risk period for sudden death while the patient waits for the next surgical procedure. The development of a less invasive approach, so-called "hybrid," postponing a major surgery outside the neonatal period, might reduce the immediate and late surgical burden on these patients. This is a retrospective study of a contemporary series of patients with HLHS seen in two separate institutions. Patients with HLHS or its variants who underwent a "hybrid" management were included in the study. Data are described as the mean and standard deviation or absolute numbers and percentage, as appropriate. From January 2004 to June 2006, 15 patients (10 male; 5 +/- 3.8 days old and 2.9 +/- 0.5 kg) were included in the study. Ten had both mitral and aortic atresia; the ascending aorta and atrial septal defect measured 2.5 +/- 1.4 and 4.9 +/- 1.2 mm, respectively. There were six hospital survivors after stage I (mortality rate 60%). During the interstage period, all but one patient needed additional procedures. One patient died of bacterial meningitis 4 months after stage I. Four patients were submitted to stage II operation at 6.6 +/- 0.5 months of age and one is waiting for the operation. All four required early reinterventions for pulmonary artery stenosis. Only one was discharged home and was not yet submitted to the third stage. The hybrid approach for HLHS was associated with poor results in this early experience from two independent institutions in a developing country. This might have been related to infrastructure and technical problems, as well as our own learning curve. Institutions working under the same conditions might face similar problems during their initial experience.
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Affiliation(s)
- Carlo B Pilla
- Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil.
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Abstract
PURPOSE OF REVIEW Despite progressive improvement in surgical results, hypoplastic left heart syndrome remains one of the congenital heart abnormalities with the greatest morbidity and mortality. Hybrid approaches to management, combining surgical and interventional catheterization procedures, have been introduced to minimize exposure to cardiopulmonary bypass, and improve outcomes for these high-risk infants. RECENT FINDINGS First-stage palliation of hypoplastic left heart syndrome has been performed as a hybrid procedure combining surgical pulmonary artery banding with catheterization stenting of the ductus arteriosus and balloon atrial septostomy, especially in high-risk patients. Additionally, several centers have performed second-stage palliation - bidirectional Glenn or hemi-Fontan procedures - in a manner that allows the subsequent 'Fontan' procedure to be completed in the catheterization laboratory with a covered stent. SUMMARY These innovative procedures offer the potential of an alternative management strategy for hypoplastic left heart syndrome. They have been applied to a very limited number of patients and long-term results are not available. Their role in management of hypoplastic left heart syndrome remains to be defined, especially as results of conventional surgical management continue to improve.
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Affiliation(s)
- Howard P Gutgesell
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia Health Science Center, Charlottesville, Virginia 22908-0386, USA.
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Pedra CAC, Neves JR, Pedra SRF, Ferreiro CR, Jatene I, Cortez TM, Jatene M, Souza LCB, Assad R, Fontes VF. New transcatheter techniques for creation or enlargement of atrial septal defects in infants with complex congenital heart disease. Catheter Cardiovasc Interv 2007; 70:731-9. [PMID: 17621660 DOI: 10.1002/ccd.21260] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To describe a series of 8 consecutive infants (5 with transposition of the great arteries [TGA] and 3 with hypoplastic left heart syndrome [HLHS]) who underwent nonconventional septostomy techniques. BACKGROUND For some complex congenital heart defects, an unrestrictive atrial septal defect (ASD) is essential to achieve an adequate cardiac output and/or systemic saturation. In some scenarios, the use of conventional septostomy techniques may be technically difficult, hazardous, and/or ineffective. METHODS Use of transhepatic approach, cutting balloons, and radiofrequency perforation with stenting of the atrial septum. RESULTS The size of the ASD and the oxygen saturation increased in all patients with no major complications. In those with TGA, the ASDs were considered to be of good size at the arterial switch operation. Two of the 3 patients with hybrid palliation for HLHS have developed some degree of obstruction within the interatrial stent over 2-3 months. At surgery, the stents were found to be secured within the septum with one showing significant fibrous ingrowth after uneventful removal. The other had some nonobstructive ingrowth. CONCLUSIONS Creation or enlargement of ASDs in infants using new nonconventional transcatheter techniques is feasible, safe, and effective, at least in the short-to-mid-term follow-up. Infants with TGA seem to benefit the most because the procedure results in satisfactory clinical stability for subsequent early surgical intervention. In infants with HLHS palliated by a hybrid approach, stent implantation to the atrial septum seems to buy enough time to bring them to the phase II safely despite progressive in-stent obstruction.
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Affiliation(s)
- Carlos A C Pedra
- Pediatric Cardiology Division, Hospital do Coração da Associação Sanatório Sírio, São Paulo, SP, Brazil.
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