Biventricular repair of small left ventricle in ducto-dependent neonates.

Background. Whether to perform uni or biventricular repair in ducto depende nt neonates with hypoplastic but morphologically normal left ventricle and multi level left ventricle obstructions (hypoplastic left heart syndrome cl ass III) remains unanswered. Echocardiographic criteria have been proposed for surgical decision. Hypothesis. Increased afterload and multi level left ventricle obstruction is constant. We assumed that restoration of normal loading conditions by re lief of left ventricle obstructions promotes its growth, provided that part of the cardiac output was pre operatively supported by the left ventricle, whatever the echocardiographic indices. Methods. Twenty one ducto dependent neonates presented with this anomaly. A ll had aortic coarctation associated to multi level left ventricle obstruct ion. Pre operative echocardiographic assessment showed: mean end diastolic left ventricular volume of 13.3 +/- 3.5 mL/m(2) and mean Rhodes score of -1 .43 +/- 0.9. Surgery consisted in relief of left ventricle outflow tract ob struction by coarctation repair in 21 associated to atrial septal defect cl osure in 2, aortic commissurotomy in 1 and ascending aorta enlargement in 1 . Results. There were 3 early and 3 late deaths. There was no predictive risk factor for failure. Growth of the left heart was demonstrated in most pati ents. At hospital discharge the end diastolic left ventricular volume was 1 9.4 +/- 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 reoperation rates at 5 yea rs were: 68.5 % and 40.75 %, respectively. Conclusion. Biventricular repair can be proposed to ducto dependent neonate s with hypoplastic but morphologically normal left ventricle provided that all anatomical causes of left ventricle obstruction can be relieved. Second ary growth of the left heart then occurs, however the reoperation rate is n ot low.