Abstract
Objectives. The purpose of this study was to define morphometric and hemodynamic criteria of successful performing biventricular repair in newborns and children of the first year of life with different congenital heart diseases combined with left heart structures hypoplasia.
Material and methods. Retrospective analysis of 56 patients with different congenital heart diseases combined with left heart structures hypoplasia treated at the Bakoulev National Medical Research Center within the period from 2003 to 2016. Biventricular repair was performed to all the patients who were divided into two groups. The first group (n=29) were patients who underwent one staged biventricular repair and the second one were patients who underwent staged biventricular repair (n=27). Median age at hospitalization was 35.9±55.4 days (from 1 day to 7,5 months). Median weight was 3.8±1.1 (2.17–7.6) kg. BSA was 0,24±0,047 (0.16–0.36) m2. Mitral valve Z-score at hospitalization in I group was –2.77±0.7 (–0.84…–4.14). Aortic valve Z-score –2.89±0.85 (ranged from –0.58…–4.5). End-diastolic left ventricular volume was 21.3±3.99 (16–35) ml/m2. Mitral valve Z-score at hospitalization in II group was –3.54±0.74 (–1.55…–4.7). Aortic valve Z-score –4.35±1.11 (ranged from –2.63…–7.04). End-diastolic left ventricular volume was 17.66±3.06 (12–22) ml/m2. Patients who died after operation in case of left heart failure (n=8) become control group.
Results. In case if mitral valve has morphological abnormalities or Z-score at hospitalization is less than –4.5, aortic valve Z-score less than –6, left ventricular outflow tract Z-score less than –6, left heart/heart axis ratio less than 0.6 and end-diastolic left ventricular volume was less than 15 ml/m2, than risk of biventricular repair failure is too high and this patient needed univentricular repair. Also, the study has identified the hemodynamic and morphometric indications for one-stage and staged biventricular repair.
Conclusions. In newborns and children of the first year of life with different congenital heart diseases combined with left heart structures hypoplasia, successful biventricular repair in case of correct assessment of morphometric left heart parameters are possible in at least 85% of cases.
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About the authors
- Leo A. Bockeria, Academician of Russian Academy of Sciences and Russian Academy of Medical Sciences, President, orcid.org/0000-0002-6180-2619
- Sergey V. Kalashnikov, Cand. Med. Sc., Researcher, orcid.org/0000-0001-9163-7768
- Inessa E. Nefedova, Cand. Med. Sc., Head of Department, orcid.org/0000-0002-9221-051X
