Original ArticlesLeft ventricular growth in selected hypoplastic left ventricles: outcome after repair of coarctation of aorta
Section snippets
Patients and methods
We reviewed the medical records and echocardiographic studies of all infants treated at the Children’s Memorial Hospital in Chicago during the period 1989–1995, with an echocardiographic diagnosis of severe CoA and LV hypoplasia, who required surgical intervention by the age of 6 months. Exclusion criteria were significant aortic valve stenosis (peak Doppler gradient ≥ 36 mm Hg), aortic atresia, mitral atresia, transposition of great arteries, and common atrioventricular canal.
Results
Of a total of 72 cases reviewed, 8 infants (6 boys, 2 girls) satisfied the selection criteria. Mean age at diagnosis was 18 days (range 1–48 days), whereas the mean weight was 3.5 kg (range 2.7–4.3 kg). Presenting signs and symptoms included low cardiac output (6 patients), cyanosis (1 patient), and heart murmur (1 patient). All had associated structural cardiac anomalies (Table 1), with 4 having doppler evidence of mild valvar AS. Seven of 8 had either an atrial septal defect or patent foramen
Comment
For certain heart defects, concern about adequacy of LV size to sustain the systemic circulation has been controversial 3, 9, 10, 11. In the presence of mitral or aortic atresia, a two-ventricle repair is not feasible. Depending on institutional experience, a sequence of palliation culminating in a modified Fontan procedure, cardiac transplantation, or no treatment may be chosen. In right ventricular volume overload, as seen in total anomalous pulmonary venous connection, marked hypoplasia of
References (22)
- et al.
Relation of the echocardiographic estimate of left ventricular size to mortality in infants with severe left ventricular outflow tract obstruction
Am J Cardiol
(1981) - et al.
Critical aortic stenosis in early infancy. Anatomic and echocardiographic substrates of successful open valvotomy
J Thorac Cardiovasc Surg
(1991) - et al.
Critical aortic stenosis in the first month of lifesurgical results in 26 infants
Ann Thorac Surg
(1990) - et al.
Critical aortic stenosis. Survival and management
J Thorac Cardiovasc Surg
(1987) - et al.
Repair of interrupted aortic archa ten-year experience
J Thorac Cardiovasc Surg
(1996) - et al.
Echocardiographic estimation of critical left ventricular size in infants with isolated aortic valve stenosis
J Am Coll Cardiol
(1991) - et al.
Aortoventriculoplasty with the pulmonary autograftthe “Ross-Konno” procedure
J Thorac Cardiovasc Surg
(1996) - et al.
Which two ventricles can-not be used for a biventricular repair?Echocardiographic assessment
Ann Thorac Surg
(1998) - et al.
Conditions with right ventricular pressure and volume overload, and a small left ventricle“hypoplastic” left ventricle or simply a squashed ventricle
J Am Coll Cardiol
(1997) - et al.
Possibility of postnatal left ventricular growth in selected infants with non-apex-forming left ventricles
Am Heart J
(1997)
Cited by (32)
Midterm follow-up after biventricular repair of the hypoplastic left heart complex
2015, Annals of Thoracic SurgeryComparability of Z-score equations of cardiac structures in hypoplastic left heart complex
2013, Journal of the American Society of EchocardiographyCitation Excerpt :They preclude comparison of series. Alboliras et al.13 investigated the length of the left ventricle and the short-axis diameter of the left ventricle in hypoplasia of the left ventricle in patients with severe coarctation. They concluded that relief of the coarctation results in the growth of the very small left ventricle, particularly when the aortic and mitral diameters are satisfactory, and the LV length is 80% of the right ventricular length.
Long-term follow-up of neonatal coarctation and left-sided cardiac hypoplasia
2013, American Journal of CardiologyCitation Excerpt :Furthermore, none of our patients underwent reintervention for LV inflow or outflow obstruction after intermediate follow-up. Although several investigators have shown more encouraging short-term outcomes after neonatal CoA repair in the setting of left-sided cardiac hypoplasia,5–7,15 concerns remain that longstanding LV diastolic dysfunction might lead to the late development of pulmonary hypertension from chronic elevation of LV filling pressures and pulmonary venous hypertension.16 We were able to show that with ≥15 years of follow-up, all but 1 patient with measured tissue Doppler indexes had normal filling pressures according to an E/e′ ratio of <12.17
Borderline hypoplasia of the left ventricle in neonates: Insights for decision-making from functional assessment with magnetic resonance imaging
2008, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Predictors of early postoperative outcome must address whether the LV, after BV repair, is able to generate enough cardiac output to sustain the systemic circulation. Nearly all published predictors, however, are based on 2-dimensional anatomic rather than functional, indices.13-16 At our institution, there are two indications for cardiac catheterization in patients with marginally small LVs: One is to outline anatomy that cannot be detailed by echocardiography (or MRI), which was not the case in any of the patients presented here.
Outcome and Growth Potential of Left Heart Structures After Neonatal Intervention for Aortic Valve Stenosis
2007, Journal of the American College of CardiologyAortic Atresia or Severe Left Ventricular Outflow Tract Obstruction with Ventricular Septal Defect: Results of Primary Biventricular Repair in Neonates
2006, Annals of Thoracic SurgeryCitation Excerpt :Although the patients in the current report had very abnormal aortic valves, the mitral valve and LV dimensions fell within the normal range (−2 <z scores < 2). Even in the setting of modest LV hypoplasia, there appears to be the potential for LV growth [5–7, 13]. McElhinney and colleagues [5] in their review of 113 neonates who had undergone balloon valvuloplasty were able to demonstrate that LV end-diastolic dimensions normalized within the first 1 to 2 years of life.