Interstage Clinic

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Special Care for High Risk Infants with Heart Defects

Single ventricle heart defects are the most complex and difficult heart defects to treat. Examples of some single ventricle heart defects are: hypoplastic left heart syndrome, double inlet left ventricle, and tricuspid atresia. Most infants with single ventricle heart defects need two surgeries within the first six months of life.

The first surgery is performed shortly after birth. It includes placement of a shunt (BT shunt, Sano shunt, or central shunt). This allows more blood to reach the lungs.

The second surgery is performed between four to six months of age. It creates a more stable path for blood to flow to the lungs that will grow with the child.

We also follow some infants without single ventricle who are temporarily treated with a shunt or stent until they can have repair of their defect.

Interstage Period

The time between the surgeries is called the interstage period. The goal of the single ventricle clinic is to help the child to grow and remain healthy.

This is a time of high risk for infants with single ventricle and systemic to pulmonary shunts. These infants need to be watched closely to spot problems before they become life-threatening. Infants are seen by the pediatric cardiology Interstage Clinic team every 2 to 4 weeks and contacted by phone in between visits. Parents watch for "red flags." These are reasons to call the cardiac team. Someone from the pediatric cardiology care team is on call 24 hours a day to answer questions or concerns as they arise.

Red Flags

Weight gain less than 60 grams (2 oz) over 4 days
Oxygen saturations less than 70%
Breathing faster or harder than normal
Not able to tolerate feedings (vomiting or diarrhea)
Fast heart rate (over 180 when calm or over 200 anytime)
Fever greater than 100.5 F
Excessive fussiness

The single ventricle clinic at University of Iowa Stead Family Children’s Hospital is part of the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). This is a group of more than 50 pediatric cardiac centers across the country. The purpose is to improve care for children with complex congenital heart disease.