Atrioventricular Inflow and Subsequent Ventricular Growth After Staged Ventricular Recruitment for Unbalanced...

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Cardiac Surgery

Background:

• Unbalanced atrioventricular canal (uAVC) defects present challenges in pediatric cardiac surgery.
• Staged ventricular recruitment, involving atrial septation without VSD closure, is a strategy for uAVC.
• Variable growth of the hypoplastic ventricle post-recruitment necessitates understanding predictive factors.

Purpose of the Study:

• To investigate the correlation between atrioventricular inflow size into the hypoplastic ventricle and its subsequent growth after staged ventricular recruitment.
• To evaluate the role of atrioventricular inflow jet width in predicting ventricular growth and informing surgical management in uAVC.

Main Methods:

• Retrospective review of 53 patients with uAVC undergoing staged ventricular recruitment (2011-2024).
• Intraoperative transesophageal echocardiography assessed atrioventricular inflow jet width.
• Cardiac MRI measured hypoplastic ventricle end-diastolic volume index (EDVI) pre- and post-recruitment.

Main Results:

• Pre-recruitment inflow width correlated with prerecruitment EDVI (r=0.56, P<.001).
• Post-recruitment, both inflow jet width (5.4 to 7.5 mm, P<.001) and EDVI (31 to 46 mL/m², P<.001) significantly increased.
• Immediate post-recruitment inflow width correlated with interval EDVI changes (r=0.62, P<.001), particularly in patients undergoing biventricular conversion.

Conclusions:

• Staged ventricular recruitment effectively promotes hypoplastic ventricle growth and facilitates biventricular conversion in uAVC.
• Atrioventricular inflow jet width post-recruitment is a key predictor of subsequent ventricular growth.
• This finding can guide intraoperative decisions for optimizing atrioventricular inflow and improving outcomes in uAVC management.