Introduction: A hybrid intervention is a joint procedure involving
the interventional cardiologist and the cardiac surgeon. At our
institution we have opted for this type of approach in congenital
heart disease since 2005. We report here our initial experience.
Cases:
1. A 3 year old boy with double aortic arch and multiple muscular
ventricular septal defects (VSD),was readdressed for pulmonary
band (PAB) removal and residual VSD closure after previous palliation.
After surgical removal of the PAB, the surgeon provided
a minimal transventricular access for placement of a 6mm
Amplatzer® muscular VSD occluder by the cardiologist under
transoesophageal guidance. The patient was extubated the same
day and discharged after 5 days.
2. An 8 year old girl with Williams syndrome was followed for
two large VSDs and severe peripheral pulmonary arteries (PA)
stenosis. The membranous VSD was closed surgically, the muscular
VSD during the same operation by direct placement of a
12 mm Amplatzer® muscular VSD occluder. During rewarming,
balloon angioplasty of peripheral PA stenosis was achieved
under fluoroscopy. Patient was extubated the following day and
discharged after 8 days.
3. A 9 year old boy post tetralogy of Fallot repair had severe distal
stenosis of the right ventricular to PA conduit.With patient on
partial cardiopulmonary bypass, an incision was made on the conduit
and a CP 8 Zig 16 stent placed on the stenosis. The child
passed on full bypass and the definitive placement of the stent
achieved. The child was extubated at the end of the intervention
and discharged after 6 days.
4. A newborn presented at 2 days life with complex aortic arch
anatomy: left aortic arch and right descending thoracic aorta
perfused directly from a right arterial duct and left PA atresia.
The arterial duct was stented with a Genesis XD stent dilated
at 7mm. Two days later the cardiac surgeon made banded the
right PA. The child was extubated after the operation and discharged
a week later.
Conclusion: Hybrid approach opens new ways of correction or
palliation in congenital heart disease with encouraging results and
less morbidity.