Tailored strategy to match anatomy and physiology with intervention can improve outcomes of symptomatic neonates with Ebstein anomaly.

Objective: Neonatal presentation of Ebstein anomaly (EA) represents the most severe form of this condition. Despite significant advances, operative mortality remains high and management decisions represent a formidable challenge. We used a strategy aimed to match anatomy and physiology with type and time of intervention to increase survival.

Hybrid palliation for critical systemic outflow obstruction: neither rapid stage 1 Norwood nor comprehensive stage 2 mitigate consequences of early risk factors.

Objective: Hybrid palliation with branch pulmonary artery banding (bPAB) has become increasingly common in the early management of patients with critical left ventricular outflow obstruction. Optimal subsequent surgical palliation remains undefined.

Methods: We retrospectively reviewed patients undergoing initial bPAB for single ventricle physiology with systemic outflow obstruction (2001-2013, n = 37).

Cone reconstruction and ventricular septal defect closure for neonatal Ebstein's anomaly.

Neonatal presentation of Ebstein's anomaly is associated with significant morbidity and mortality. We illustrate the technical aspects of the cone procedure and the closure of a ventricular septal defect, to achieve biventricular repair in a neonate. This includes the assessment of the leaftlet apparatus, detachment, division of chordae, annular plication, leaflet rotation and reinsertion in the neoannulus.

Bailout after failed biventricular management of critical aortic stenosis: another application of the hybrid approach.

The decision between a single-ventricle and biventricular strategy can be particularly difficult in patients with critical left ventricular outflow obstruction who have marginal left ventricular size or function. Overzealous pursuit of a biventricular strategy in borderline cases can lead to death or require conversion to a single-ventricle physiology at increased risk. We describe novel use of the hybrid approach as a bailout option for a patient with critical aortic stenosis who, despite balloon valvuloplasty, exhibited persistent severe left ventricular dysfunction.