Growth of left heart structures following the hybrid procedure for borderline hypoplastic left heart.
OBJECTIVE
The 'hybrid' procedure is an alternative to the Norwood operation in classical hypoplastic left heart syndrome to support the systemic circulation until subsequent palliation. This approach has been extended to infants with the borderline development of left heart structures. We investigated whether or not a hybrid procedure for 'borderline' cases of underdevelopment of the left heart would lead to any improvement in the growth of those structures relative to body size or would impact on eventual repair.


RESULTS
Serial echocardiograms were reviewed in cases in whom left heart development was judged borderline for adequacy to support the systemic circulation. z-scores of left heart structures and aortic discriminant scores were plotted sequentially following the hybrid procedure and random-coefficient linear-mixed models were applied to quantify growth rates. Seven infants met the inclusion criteria. At birth, the median (range) of aortic discriminant scores was -2.67 (-3.26 to -1.22), suggesting that a biventricular repair would not be feasible. Following a hybrid procedure, aortic discriminant scores increased with time and three infants were managed with a biventricular repair. The rate of change was significantly higher in infants who achieved a biventricular repair compared with those who did not (P = 0.01).


CONCLUSIONS
The hybrid procedure allows time for growth of left heart structures in selected infants, and serial echocardiography may assist in identifying those children who may ultimately achieve a biventricular circulation.
Ballard
George
G
Department of Congenital Heart Disease, Evelina Children's Hospital, Guy's and St Thomas Hospital Foundation Trust, 6th Floor, Westminster Bridge Road, London SE1 7EH, UK.
Tibby
Shane
S
Miller
Owen
O
Krasemann
Thomas
T
Rosenthal
Eric
E
Anderson
David
D
Austin
Conal
C
Qureshi
Shakeel
S
Simpson
John
J
D004452:Echocardiography; D005260:Female; D006321:Heart / Q000254:growth & development*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D058327:Norwood Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome