HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Harold M. Burkhart Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Von Bergen, N. H. Articles by Bartlett, H. L. Search for Related Content PubMed Articles by Von Bergen, N. H. Articles by Bartlett, H. L. Related Collections Cardiac - physiology Congenital - cyanotic

J Thorac Cardiovasc Surg 2007;134:1355-1356
© 2007 The American Association for Thoracic Surgery

Brief Communication

Complete cavopulmonary shunt completion after in utero balloon atrial septoplasty for hypoplastic left heart syndrome

^a Department of Pediatric Cardiology, the University of Iowa Children’s Hospital, Iowa City, Iowa
^b Department of Cardiovascular Surgery, the Mayo Clinic, Rochester, Minn
^c Department of Pediatric Cardiology, the Cleveland Clinic, Cleveland, Ohio
^d Department of Obstetrics, Gynecology & Reproductive Sciences, the University of Pittsburgh, Pittsburgh, Pa
^e Department of Pediatric Cardiology, the Denver Children’s Hospital, Denver, Colo.

Received for publication July 9, 2007; accepted for publication July 19, 2007.

^_* Address for reprints: Nicholas H. Von Bergen, MD, The University of Iowa Children’s Hospital, 200 Hawkins Dr, Iowa City, IA 52242. (Email: Nicholas-vonbergen@uiowa.edu).

The first 20% of the full text of this article appears below.

Hypoplastic left heart syndrome (HLHS) with intact or restrictive atrial septum is associated with mortality as high as 50% to 80%.^1,2 There is a theoretical benefit to in utero creation of an atrial septal defect, although to date this procedure has been associated with a high mortality without conclusive improvement in survival or alteration of hemodynamics.^1,3 We describe the case of a patient successfully treated by in utero atrial septostomy who subsequently progressed through the complete cavopulmonary shunt procedure. To our knowledge, this is the first such case to be described in the literature.

Clinical Summary

Prenatal history
At 20 weeks’ gestation, a fetal echocardiogram demonstrated severe aortic stenosis with minimal antegrade flow and a dilated, poorly contractile left ventricle. Four weeks later there was progression to HLHS. No interatrial flow could be demonstrated and the pulmonary venous flow pattern was consistent with severe obstruction (Figure 1).

View larger version (23K):   Figure 1. Right upper pulmonary venous flow patterns by Doppler ultrasound. A, Before septoplasty with a highly restrictive pulmonary venous flow pattern. B, After septoplasty with a normal pulmonary venous flow pattern.