{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T23:40:37Z","timestamp":1792280437624,"version":"4.4.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:00:00Z","timestamp":1792195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hypoplastic left heart syndrome has been historically palliated with the surgical Norwood or hybrid procedures. Transcatheter placement of pulmonary flow restrictors (PFR) with prostaglandin to maintain an unobstructed ductus arteriosus has emerged as an option for single-ventricle patients that are poor surgical candidates. High-fidelity physiologic data has been used to predict outcomes in interstage patients. This study aimed to characterize the acute hemodynamic effects of transcatheter flow restrictors on pulmonary to systemic blood flow ratio using physiologic data.\u00a0A single-center retrospective review of 10 patients who underwent transcatheter flow restrictor placement was performed. High-fidelity physiologic data (1-second resolution) from before, during, and after flow restrictor placement were utilized. Data were aggregated with the Sickbay Clinical Platform. An autoregressive integrated moving average model was used to compare variables of interest before, during, and after flow restrictor placement.\u00a0A total of 10 patients were included in the study for a total of 123,509 patient seconds of monitoring. A statistically significant decrease in pulmonary-to-systemic blood flow ratio, systemic saturation, and renal oxygen extraction, and an increase in blood pressure, were observed during and after PFR placement.\u00a0Flow restrictor placement is associated with an acute decrease in calculated pulmonary to systemic blood flow ratio and an increase in calculated renal oxygen extraction ratio (related to an increase in systemic oxygen delivery). More importantly, this study demonstrates that high-fidelity physiologic data platforms can be used for real-time assessment of the effect of pulmonary artery flow reducers. Eventually, clinical decision algorithms may be able to guide the pulmonary artery flow reducer strategy, both intra-procedurally and afterward.<\/jats:p>","DOI":"10.1007\/s00246-026-04509-4","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T12:16:29Z","timestamp":1792239389000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immediate Hemodynamic Effects of Pulmonary Artery Flow Restrictors in Univentricular Circulation: Hypothesis-Generating Insights from High-Fidelity Physiologic Streaming Data Using Machine-Learning"],"prefix":"10.1007","author":[{"given":"Jeremy L.","family":"Fox","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan W.","family":"Nugent","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor P.","family":"O\u2019Halloran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Tannous","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Evans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit S.","family":"Loomba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,17]]},"reference":[{"issue":"1","key":"4509_CR1","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1056\/nejm198301063080106","volume":"308","author":"WI Norwood","year":"1983","unstructured":"Norwood WI, Lang P, Hansen DD (1983) Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med 308(1):23\u20136. https:\/\/doi.org\/10.1056\/nejm198301063080106","journal-title":"N Engl J Med"},{"issue":"6","key":"4509_CR2","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1136\/hrt.69.6.551","volume":"69","author":"JL Gibbs","year":"1993","unstructured":"Gibbs JL, Wren C, Watterson KG, Hunter S, Hamilton JR (1993) Stenting of the arterial duct combined with banding of the pulmonary arteries and atrial septectomy or septostomy: a new approach to palliation for the hypoplastic left heart syndrome. Br Heart J 69(6):551\u20135. https:\/\/doi.org\/10.1136\/hrt.69.6.551","journal-title":"Br Heart J"},{"issue":"3","key":"4509_CR3","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1053\/j.semtcvs.2007.07.002","volume":"19","author":"FA Pigula","year":"2007","unstructured":"Pigula FA, Vida V, Del Nido P, Bacha E (2007) Contemporary results and current strategies in the management of hypoplastic left heart syndrome. Semin Thorac Cardiovasc Surg 19(3):238\u201344. https:\/\/doi.org\/10.1053\/j.semtcvs.2007.07.002","journal-title":"Semin Thorac Cardiovasc Surg"},{"issue":"14","key":"4509_CR4","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.1161\/CIRCULATIONAHA.120.047668","volume":"142","author":"D Schranz","year":"2020","unstructured":"Schranz D, Esmaeili A, Schrewe R, Kerst G, Akintuerk H (2020) Hypoplastic left heart stage I: no Norwood, no hybrid. Circ 142(14):1402\u20131404. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.120.047668","journal-title":"Circ"},{"key":"4509_CR5","doi-asserted-by":"publisher","DOI":"10.1161\/circ.148.suppl_1.14032","author":"F Sperotto","year":"2023","unstructured":"Sperotto F, Lang N, Nathan M et al (2023) Transcatheter Palliation With Pulmonary Artery Flow Restrictors in Neonates With Congenital Heart Disease: Feasibility, Outcomes, and Comparison With a Historical Hybrid Stage 1 Cohort. Circulation. https:\/\/doi.org\/10.1161\/circ.148.suppl_1.14032","journal-title":"Circulation"},{"issue":"25","key":"4509_CR6","doi-asserted-by":"publisher","first-page":"3184","DOI":"10.1016\/j.jacc.2021.04.072","volume":"77","author":"CG Rusin","year":"2021","unstructured":"Rusin CG, Acosta SI, Vu EL, Ahmed M, Brady KM, Penny DJ (2021) Automated prediction of cardiorespiratory deterioration in patients with single ventricle. J Am Coll Cardiol 77(25):3184\u20133192. https:\/\/doi.org\/10.1016\/j.jacc.2021.04.072","journal-title":"J Am Coll Cardiol"},{"key":"4509_CR7","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2025.08.061","author":"C Buyukgoz","year":"2025","unstructured":"Buyukgoz C, Sathanandam S, Tailor N et al (2025) Outcomes after pulmonary artery flow reducer implantation in high-risk neonates with congenital heart disease and pulmonary overcirculation. Ann Thorac Surg. https:\/\/doi.org\/10.1016\/j.athoracsur.2025.08.061","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"4509_CR8","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1007\/s00246-021-02626-w","volume":"42","author":"S Nageotte","year":"2021","unstructured":"Nageotte S, Shahanavaz S, Eghtesady P, Balzer D (2021) Total transcatheter stage 1: a word of caution. Pediatr Cardiol 42(6):1410\u20131415. https:\/\/doi.org\/10.1007\/s00246-021-02626-w","journal-title":"Pediatr Cardiol"},{"issue":"5","key":"4509_CR9","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1007\/s13239-023-00674-2","volume":"14","author":"SB Kizilski","year":"2023","unstructured":"Kizilski SB, Recco DP, Sperotto F et al (2023) Transcatheter pulmonary artery banding in high-risk neonates: in-vitro study provoked by initial clinical experience. 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