Left ventricular outflow tract stenting in late presenting transposition physiology with ventricular shunt and pulmonary stenosis: a case series

Left ventricular outflow tract (LVOT) stenting is a palliative strategy for late-presenting d-transposition of the great arteries (d-TGA) with ventricular septal defect (VSD) and severe LVOT obstruction (LVOTO), particularly in settings with limited surgical resources. We reviewed six patients who underwent LVOT stenting at our center. Median age at intervention was 6 months (Q1–Q3: 25 days–18 months) and median weight was 4.0 kg (Q1–Q3: 3.3–5.1 kg). Median stent length was 23 mm (Q1-Q3, 15–29 mm). Median pre-procedural arterial oxygen saturation was 53.5% (Q1–Q3: 51–65%), increasing to median 85.5% (Q1–Q3: 84–89%) following stent implantation. All procedures were technically successful, with no major intraprocedural complications. Median follow-up duration was 6 months (Q1–Q3: 4 days–6 months). Two patients died during follow-up (at 4 days and 6 months), four proceeded to bidirectional cavopulmonary shunt (BCPS) as part of a Fontan pathway, and one had undefined outcomes. No patient achieved biventricular repair. In this series, LVOT stenting provided effective short-term relief of obstruction and improved systemic oxygenation but functioned primarily as a bridge toward single-ventricle (Fontan) palliation, rather than toward biventricular repair.