A case report on stent placement in a fetus with hypoplastic left heart syndrome and intact interatrial setptum: first choice alternative standardized approach from left pulmonary vein

Background Fetuses with hypoplastic left heart syndrome (HLHS) and intact interatral septum (IS) have a high perinatal mortality due to the impossibility to guarantee oxygenation at birth. The most effective way to manage this condition seems to create an interatrial communication in utero. We describe a case of IS stenting, performed through an alternative technical approach. Case presentation A 32 weeks gestation baby presented with HLHS with intact IS. A left side approach was electively planned, targeting a grossly dilated left pulmonary vein. This maneuver, avoiding the direct puncture of a cardiac chamber, allowed to more safely use a larger cannula and to deploy a larger stent. The procedure was uneventful and granted an adequate flow until the delivery. Conclusions Elective interatrial septoplasty through a left side approach seems to be promising in terms of safety and efficacy.