Short-term results in infants with multiple left heart obstructive lesions

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease Surgery
• Echocardiography in Neonates

Background:

• Neonates with multiple left heart obstructive lesions present complex surgical decisions.
• Predictors for successful biventricular (2V) repair in these infants are not well-established.
• Risk stratification is essential for optimizing surgical pathways.

Purpose of the Study:

• To identify predictors of successful biventricular (2V) repair in neonates with multiple left heart obstructive lesions.
• To assess anatomic and echocardiographic factors associated with 2V repair outcomes.
• To evaluate the feasibility of 2V repair in this challenging patient group.

Main Methods:

• Retrospective review of 19 neonates with ≥2 left heart obstructive lesions (July 2015-August 2017).
• Exclusion of patients with aortic/mitral atresia or critical aortic stenosis.
• Analysis of initial echocardiograms for ventricular dimensions, valve annulus size, valve morphology, VSD, and coarctation. Outcomes included successful 2V repair, complications, and reinterventions.

Main Results:

• 14 neonates underwent 2V repair; 5 underwent 1V palliation.
• The left ventricular to right ventricular (LV:RV) diastolic longitudinal ratio >0.75 and mitral/tricuspid ratio <0.8 were found in 13/14 of the 2V group.
• The LV:RV ratio and aortic valve z-score were significantly larger in the 2V group. All 1V patients had a non-apex forming LV. No mortality observed up to 3 years.

Conclusions:

• Excellent short-term and midterm surgical results were achieved in the 2V repair population.
• The LV:RV diastolic longitudinal ratio appears to be a valuable tool for risk stratification in predicting successful 2V repair.
• This ratio may aid surgical decision-making even in cases with a small mitral valve.