Interventions for Univentricular Hearts

Patients with single ventricle physiology pose a wide variety of therapeutic challenges throughout the staged palliation strategy. This section describes common transcatheter and hybrid interventions for this patient population. The chapter is organized chronologically and follows the stages of single ventricle palliation: pre-Glenn, post-Glenn, and post-Fontan. The most commonly performed pre-Glenn interventions include stenting of the patent ductus arteriosus (PDA), interventions for obstructed shunts or conduits, stenting of the right ventricular outflow tract (RVOT), as well as hybrid palliation of hypoplastic left heart syndrome (HLHS). Following bidirectional Glenn procedure, interventions include balloon angioplasty or stenting of the proximal branch pulmonary arteries (or Glenn anastomosis) and treatment of pulmonary artery thrombosis. After Fontan completion, fenestration closure or creation are frequent interventions as well as stenting of an unobstructed Fontan baffle. Additional transcatheter procedures, such as aortic arch interventions and occlusion of venous or aortopulmonary collaterals, may be needed at any time along the single ventricle pathway and will be discussed in the final section.