The reported incidence of necrotising enterocolitis in neonates with complex CHD with ductus-dependent systemic circulation ranges from 6.8 to 13% despite surgical treatment; the overall mortality is between 25 and 97%. The incidence of gastrointestinal complications after hybrid palliation for neonates with ductus-dependent systemic circulation still has to be defined, but seems comparable with that following the Norwood procedure.

We reviewed the incidence of gastrointestinal complications in a series of 42 consecutive neonates with ductus-dependent systemic circulation, who received early hybrid palliation associated with a standardised feeding protocol.

The median age and birth weight at the time of surgery were 3 days (with a range from 1 to 10 days) and 3.07 kg (with a range from 1.5 to 4.5 kg), respectively. The median ICU length of stay was 7 days (1–70 days), and the median hospital length of stay was 16 days (6–70 days). The median duration of mechanical ventilation was 3 days. Hospital mortality was 16% (7/42). In the postoperative period, 26% of patients were subjected to early extubation, and all of them received treatment with systemic vasodilatory agents. Feeding was started 6 hours after extubation according to a dedicated feeding protocol. After treatment, none of our patients experienced any grade of necrotising enterocolitis or major gastrointestinal adverse events.

Our experience indicates that the combination of an “early hybrid approach”, systemic vasodilator therapy, and dedicated feeding protocol adherence could reduce the incidence of gastrointestinal complications in this group of neonates. Fast weaning from ventilatory support, which represents a part of our treatment strategy, could be associated with low incidence of necrotising enterocolitis.

To assess the feasibility of interatrial stenting for left atrial decompression in infants with hypoplastic left heart syndrome treated by a “hybrid-approach”, with bilateral surgical banding of the pulmonary arteries and percutaneous stenting of the arterial duct.

We stented the atrial septum in 5 infants aged from 21 to 77 days, making the intervention as an elective procedure in 4, but as a rescue procedure in the fifth patient, who had a restrictive foramen. The stents, comprising 2 Jo-stents of 17 millimetres hand-crimped on a balloon catheter with dimensions of 10 by 20 millimetres, and 3 premounted Genesis stents with dimensions of 10 by 19 millimetres, were placed using a 6 French long or short sheath by femoral venous access. The stents were expanded under fluoroscopic guidance to create a slightly diabolo-shaped form that fitted the septum.

The percutaneous interventions were successfully performed in all cases, producing significant improvement in clinical condition after placement. The saturations of oxygen increased from an average of 64% plus or minus 18% to 88% plus or minus 7%, (p < 0.05). During a mean follow up of 2.5 months, without any anticoagulant therapy, there were no complications related to the stenting. Surgical removal of the stents was uneventful during reconstruction of the aortic arch and creation of a bidirectional cavopulmonary connection in 4 patients, and during cardiac transplantation in one.

In the context of the hybrid approach, definitive decompression of the left atrium can be achieved by stenting the atrial septum in infants with hypoplastic left heart syndrome. Placement of the stents is safe and effective, with insertion in the form of a diabolo reducing the risk of dislocation, as well as embolisation of the stent.