Borderline hypoplastic left heart malformations: Norwood palliation or two-ventricle repair?
BACKGROUND
Patients with hypoplastic left heart syndrome (HLHS) and associated malformations undergo Norwood palliation or potentially a two-ventricle repair.


METHODS
Since 8/99, 8 patients with typical HLHS and two with DILV underwent Norwood/Fontan palliation (group I). Three other patients (group II) had two-ventricle repair. Anatomy was: aortic atresia, coarctation, unrestrictive VSD (patient 1), hypoplastic mitral and aortic valve, arch and LV, coarctation (patients 2 and 3). Surgical procedures were Norwood arch reconstruction with either Rastelli operation (patient 1) or ASD-closure (patients 2 and 3).


RESULTS
Operative mortality in group I was 1/8 (day 22; RV-failure). Two patients died before Glenn (sepsis, RV-failure). Six patients underwent Glenn procedure successfully. No patient died in group II. Echocardiography after 13 +/- 7.4 months showed mild homograft dysfunction (patient 1) and an LVOT-gradient of 20 mmHg (patient 3). Clinical condition of all survivors in both groups is good.


CONCLUSIONS
Some anatomical subsets of HLHS with borderline mitral valves and small left ventricles may undergo two-ventricle repair despite severe LVOTO. Mortality and morbidity seem to be lower, but selection criteria are so far not defined.
Daebritz
S H
SH
Clinic of Cardiac Surgery, University Hospital Grosshadern, Munich, Germany. Sdaebritz@aol.com
Tiete
A R
AR
Rassoulian
D
D
Roemer
U
U
Kozlik-Feldmann
R
R
Sachweh
J S
JS
Netz
H
H
Reichart
B
B
D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D008297:Male; D010166:Palliative Care