Fig. 5.

Shows the schematic picture of Hybrid stage I consisting of duct stenting (DA stent), bilateral pulmonary banding (bPAB), and interatrial septum manipulation by stent placement. Left atrial (LAP) decompression to a pressure level of the right atrium (RAP) is an important part of a balanced parallel turned pulmonary to systemic circulation. The echocardiography shows an effective bPAB by its typical flow-pattern, but despite an effective bPAB, the systolic right-to-left flow through the duct is accompanied by a diastolic left-to-right reflow; one important indication to reduce the systemic vascular resistance without jeopardizing coronary blood flow. Additionally, bisoprolol reduces heart rate, which improves single ventricle filling; all factors together diminish pulmonary congestion, reduce total and myocardial oxygen consumption, and improve the baby’s functional class