Stent Implantation in neonatal patients with hypoplastic left heart syndrome (HLHS)

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ACKNOWLEDGEMENT

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

DECLARATION

I, [type your full first names and surname here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the University.

Signed __________________ Date _________________

ABSTRACT

This thesis is based on the Stent Implantation in neonatals with hypoplastic left heart syndrome (HLHS). In the recent era, no congenital heart defect has undergone a more dramatic change in diagnostic approach, management, and outcomes than hypoplastic left heart syndrome (HLHS). Although just over 30 years ago, comfort care was the only option, there are now a number of therapeutic options available for families, though there continues to be a debate as to the optimal treatment approach. Although the 3-stage treatment approach to HLHS is now well founded, there is significant variation among centers. Over the last 20 years, the usefulness of stents in neonatal with CHD has become well established. Stent implantation is now considered to be a safe and effective method in relieving a wide variety of pre- and post-operative vascular stenoses not amenable to pure balloon dilatation. Thus, stent therapy is now considered to be the standard and first-line treatment for CoA in adults or post-operative PA branch stenoses. Bilateral PA banding was described by Dr. Norwood based on his early experience of surgical palliation for HLHS before he established the 'Norwood procedure' and has been an option to stabilize critically ill neonates with HLHS. This procedure, however, did not become a hybrid procedure until ductal stenting became clinically available.

Table Of Contents

ACKNOWLEDGEMENTII

DECLARATIONIII

ABSTRACTIV

Background of the study1

Problem Statement2

Purpose of the study2

Significance of the study3

Rationale of the study5

LITERATURE REVIEW8

Fetal Heart Development8

When does it start9

Stages of development10

Normal Physiology of fetal circulation13

Main Congenital Heart Defects of NEWBORNS; (for example)20

Hypoplastic Left Heart Syndrome23

Stenting48

RESULTS51

ANALYSIS OF RESULTS52

CONCLUSION59

BIBLIOGRAPHY64

INTRODUCTION

Background of the study

Hypoplastic left heart syndrome (HLHS) is a continuum which can affect all left sided cardiac structures, from the mitral valve to the aortic arch. Since Norwood's first description of surgical palliation in 1981,1 HLHS has been managed either by staged palliation in the majority of cases, or, in a minority, by primary cardiac transplantation. In this article we will discuss the early medical and surgical management of the neonate with HLHS, focusing on the evolution of new surgical strategies, and on the changing emphasis of peri-operative circulatory management on the intensive care unit. (Tanoue, 2004: 1965-71)

The goals of Stage I palliation are to relieve systemic outflow tract obstruction, provide nonrestrictive coronary blood flow and adequate pulmonary blood flow, and create a nonrestrictive atrial septal defect. The second stage eliminates the existing, high-pressure, arterial or ventricular source of pulmonary blood flow and connects the superior vena cava (SVC) with the pulmonary artery. Conversion to a bidirectional superior cavopulmonary shunt results ...