Spectrum and influence of hypoplasia of the left heart in Neonatal aortic coarctation

Obstruction of the left ventricular outflow tract may be associated with hy poplasia of the left heart, which importantly influences the options for tr eatment. Although the influence of the size of the left heart on the outcom e for critical aortic stenosis has been described, less is known about the spectrum of such hypoplasia seen with neonatal aortic coarctation, and how this influences outcome. To determine, first, the spectrum and influence of hypoplasia of the left heart in neonatal coarctation, second, if the previ ously described critical values for adequacy of the left heart in neonates with critical aortic stenosis are applicable to neonates with coarctation, and, third, if any of the variables or associated abnormalities are risk fa ctors fur recoarctation, we studied 63 neonates who underwent repair of coa rctation. From the initial echocardiogram, we measured multiple structures in the left heart, and calculated a score for adequacy as has been done for critical aortic stenosis. The sizes were compared to previously reported m inimal values. We then analyzed the influence of the variables and the asso ciated anomalies on outcome. There were no deaths. There was a broad spectr um of sizes that did not correlate with the need for re-intervention. The c alculated score for adequacy would have predicted survival in only 56% of t he patients, and 73% of the neonates had at least one parameter measured in the left heart below the previously reported minimal values. There is, the refore, a broad spectrum of sizes for the left heart in neonates with aorti c coarctation that is not predictive of outcome. Minimal sizes, and the sco re for adequacy used for critical aortic stenosis, are not applicable to ne onates with coarctation.