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. 2023 May 11;10(5):859.
doi: 10.3390/children10050859.

Hybrid Palliation for Hypoplastic Borderline Left Ventricle: One More Chance to Biventricular Repair

Lilia Oreto  1   2 , Giuseppe Mandraffino  1 , Rita Emanuela Calaciura  2 , Daniela Poli  2 , Placido Gitto  2 , Michele Benedetto Saitta  2 , Ermanno Bellanti  2 , Scipione Carerj  1 , Concetta Zito  1 , Fiore Salvatore Iorio  2 , Paolo Guccione  2 , Salvatore Agati  2
Affiliations

Hybrid Palliation for Hypoplastic Borderline Left Ventricle: One More Chance to Biventricular Repair

Lilia Oreto et al. Children (Basel). .

Abstract

Treatment options for hypoplastic borderline left ventricle (LV) are critically dependent on the development of the LV itself and include different types of univentricular palliation or biventricular repair performed at birth. Since hybrid palliation allows deferring major surgery to 4-6 months, in borderline cases, the decision can be postponed until the LV has expressed its growth potential. We aimed to evaluate anatomic modifications of borderline LV after hybrid palliation. We retrospectively reviewed data from 45 consecutive patients with hypoplastic LV who underwent hybrid palliation at birth between 2011 and 2015. Sixteen patients (mean weight 3.15 Kg) exhibited borderline LV and were considered for potential LV growth. After 5 months, five patients underwent univentricular palliation (Group 1), eight biventricular repairs (Group 2) and three died before surgery. Echocardiograms of Groups 1 and 2 were reviewed, comparing LV structures at birth and after 5 months. Although, at birth, all LV measurements were far below the normal limits, after 5 months, LV mass in Group 2 was almost normal, while in Group 1, no growth was evident. However, aortic root diameter and long axis ratio were significantly higher in Group 2 already at birth. Hybrid palliation can be positively considered as a "bridge-to-decision" for borderline LV. Echocardiography plays a key role in monitoring the growth of borderline LV.

Keywords: biventricular repair; borderline left ventricle; echocardiography; hybrid palliation; hypoplastic left heart syndrome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Panel (A). Apical 4−chamber view of a severely underdeveloped left ventricle with mitral annular hypoplasia. Panel (B). Subcostal left oblique view showing severe aortic annular and arch hypoplasia; aortic stenosis is evident with color−Doppler. Antegrade aortic flow is obstructed but still present.
Figure 2
Figure 2
Study design. Among all patients with hypoplastic borderline left ventricle, we distinguished 2 groups according to the subsequent surgical strategy they underwent after interstage: Group 1, univentricular palliation; Group 2 biventricular repair (Legend: LV, left ventricle; MS, mitral stenosis; AS, aortic stenosis; uAVSD, unbalanced atrioventricular septal defect).
Figure 3
Figure 3
Case example from Group 2. Left heart structures are shown at birth (superior panels) and after interstage (inferior panels). Mitral and tricuspid annulus, and long axis of both ventricles (A,D), aortic root and end-diastolic left ventricular diameter (B,E), and distal aortic arch diameter (C,F) are depicted in red.
Figure 4
Figure 4
Graphical representation of different parameters in Group 1 (single ventricle palliation) and Group 2 (biventricular repair) at birth (left panels) and after 5 months (right panels).
Figure 5
Figure 5
Graphical representation of different parameters in Group 1 (single ventricle palliation) and Group 2 (biventricular repair) at birth (left panels) and after 5 months (right panels).
See this image and copyright information in PMC

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