Biventricular repair approach in ducto-dependent neonates with hypoplasticbut morphologically normal left ventricle

OBJECTIVES Increased afterload and multilevel LV obstruction is constant. W e assumed that restoration of normal loading conditions by relief of LV obs tructions promotes its growth, provided that part of the cardiac output was preoperatively supported by the LV, whatever the echocardiographic indexes . BACKGROUND Whether to perform uni- or biventricular repair in ducto depende nt neonates with hypoplastic but morphologically normal LV (hypoplastic lef t heart syndrome classes II & III) remains unanswered. Echocardiographic cr iteria have been proposed for surgical decision. METHODS Twenty ducto dependent neonates presented with this anomaly. All ha d aortic coarctation associated to multilevel LV obstruction. Preoperative echocardiographic assessment showed: mean EDLVV of 12.4 +/- 3.03 ml/m(2) an d mean Rhodes score of -1.73 +/- 0.8. Surgery consisted in relief of LV out flow tract obstruction by coarctation repair in all associated to aortic co mmissurotomy in one and ASD closure in 2. RESULTS There were 3 early and 2 late deaths. Failure of biventricular repa ir and LV growth was obvious in patients with severe anatomic mitral stenos is. The other demonstrated growth of the left heart. At hospital discharge the EDLVV was 19.4 +/- 3.12 ml/m(2) (p = 0.0001) and the Rhodes score was - 0.38 +/-. 1.01 (p = 0.0003). Actuarial survival and freedom from reoperatio n rates at 5 years were 72.5% and 46%, respectively. CONCLUSIONS Biventricular repair can be proposed to ducto dependent neonate s with hypoplastic but morphologically normal LV provided that all anatomic al causes of LV obstruction can be relieved. Secondary growth of the left h eart then occurs; however, the reoperation rate is high. (C) 1999 by the Am erican College of Cardiology.