Stage I bilateral pulmonary artery banding maintains systemic flow by prostaglandin E1 infusion or a main pulmonary artery to the descending aorta shunt for hypoplastic left heart syndrome

Since 2002, we have performed bilateral pulmonary artery banding for stage I palliation and maintained systemic flow by prostaglandin E1 infusion or a main pulmonary artery to the descending aorta shunt, and here report our experience. Three of the 4 patients were diagnosed with aortic atresia/mitral atresia and 1 with aortic stenosis/mitral stenosis. Balloon atrial septostomy was performed in 2 before stage I. Bilateral pulmonary artery banding (right circumference: 10 or 14, left circumference: 10.5 to 14 mm) was performed from 7 to 19 days after birth. Systemic flow was maintained by prostaglandin E1 infusion in 2 patients and a Van Praagh procedure was performed in the other 2. Balloon atrial septostomy was required in 2 patients, and an atrial septal defect enlargement was in one during the interstage before stage II palliation, which was performed at ages 3 to 9 months. Bidirectional cavopulmonary shunt with aortic arch and coronary flow reconstruction was also performed. For patients younger than 4 months, we do not require pulmonary arterioplasty in stage II. All patients are alive and well and waiting for Fontan completion. Excellent early results were obtained for this surgical strategy that avoids the stage I Norwood palliation.