Converting an Infant with Borderline Left Heart Structures to Biventricular Circulation after an initial Hybrid Norwood Approach: A case report.

Abstract Background Hybrid approach in hypoplastic left heart syndrome (HLHS) implies placement of bilateral pulmonary artery bands and ductal stenting. This approach serves as a less invasive surgical-interventional alternative to the Norwood procedure with reported equivalent survival. Potential benefits include deferrable surgical risks and in some borderline left ventricle patients, when combined with a restrictive interatrial communication, it offers a chance for biventricular circulation(n. Case summary Term newborn with total anomalous pulmonary venous connection (TAPVC), hypoplastic left heart, small aortic arch and ASD who was multidisciplinary deemed eligible for a hybrid palliation performed on day 6 of life after TAPVC surgical correction. Subsecuently, percutaneous ductal stent implantation was performed (2 Sinus Superflex DS stents) on day 11 of life. Magnetic resonance imaging (MRI) showed a hypoplastic non-apex forming left ventricle (LV) (left ventricular end-diastolic volume index (LVEDVI) 15 ml/m2). On day 27th of life, the ASD was closed surgically with a fenestrated patch. At 2 months of age, control cardiac MRI showed striking LV growth (LVEDVI 37 ml/m2). Herein an interventional hybrid take-down was performed with dilatation of both pulmonary arterial bands and closure of the ductal stent with an Amplatzer vascular plug-II thus, achieving biventricular circulation. Discussion Hybrid approach has proven as a safe alternative to the Norwood procedure for HLHS. This case illustrates the importance of multidisciplinary care in high-risk 2 ventricular patients by means of LV rehabilitation. Further studies are needed to systematically define and understand the intricacies of potential candidates for staged biventricular repair initially managed with hybrid approach.