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Updated: Feb 19, 2026
Murine Fetal Echocardiography
Published on: February 15, 2013
Assessing the borderline ventricle in a term infant: combining imaging and physiology to establish the right course
1Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
Insights
Diagnosing and treating children with borderline ventricles presents significant challenges. Early decisions on biventricular repair versus other surgical strategies are crucial for long-term outcomes in pediatric cardiology.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Borderline ventricles in children pose diagnostic and therapeutic dilemmas.
- A borderline ventricle may not adequately support circulation, impacting surgical decisions.
- Failure of biventricular repair attempts often leads to poor outcomes, highlighting the importance of early assessment.
Purpose of the Study:
- To review the challenges in diagnosing and treating pediatric patients with borderline ventricles.
- To discuss the critical nature of early decision-making regarding surgical repair strategies.
Main Methods:
- This is a review article.
- The review synthesizes current knowledge on borderline ventricles in pediatric cardiology.
- It focuses on diagnostic challenges and treatment options.
Main Results:
- Surgical strategies for borderline right ventricles offer more flexibility with additional pulmonary blood flow sources.
- One and a half ventricle repairs show generally good outcomes, but long-term effects on exercise and quality of life require further study.
- Treating borderline left ventricles may involve multiple surgeries to promote growth, with variable success and potential for residual issues like pulmonary hypertension.
Conclusions:
- Deciding between marginal biventricular repair and Fontan circulation for pediatric patients is a complex challenge in cardiology and cardiac surgery.
- Long-term outcomes and quality of life after one and a half ventricle repairs need continued investigation.
- Management of borderline ventricles requires careful consideration of individual patient physiology and potential long-term sequelae.
Purpose Of Review:
The purpose of this review is to describe the challenges associated with the diagnosis and treatment of children with borderline ventricles. A borderline ventricle is one in which there is concern that it will not be able to support its circulation. If a biventricular repair is attempted and fails, outcome is often poor. Thus, this early decision is important.
Recent Findings:
For the borderline right ventricle, options to add an additional source of pulmonary blood flow make the surgical strategy a bit more flexible than for patients with a borderline left ventricle. In general, outcome for a so-called one and one-half ventricle repair are generally good, though the long-term outcome and the effects of this physiology on lifelong exercise performance and quality of life remain to be seen. For the small left ventricle, often multiple surgeries are required to 'force' blood into the left ventricle and potentially help it grow. Though this strategy is successful in some, in others it results in significant residual cardiac issues including pulmonary hypertension.
Summary:
Determining whether a patient will be better off in the long term with a marginal biventricular repair versus a Fontan circulation remains one of the most difficult problems in the field of pediatric cardiology and cardiac surgery.
