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Spectrum and influence of hypoplasia of the left heart in Neonatal aortic coarctation

  • Lloyd Y. Tani (a1), L. Luann Minich (a1), John A. Hawkins (a2), Edwin C. McGough (a2), Luciana T. Pagotto (a1), Garth S. Orsmond (a1) and Robert E. Shaddy (a1)...

Abstract

Obstruction of the left ventricular outflow tract may be associated with hypoplasia of the left heart, which importantly influences the options for treatment. Although the influence of the size of the left heart on the outcome for critical aortic stenosis has been described, less is known about the spectrum of such hypoplasia seen with neonatal aortic coarctation, and how this influences outcome. To determine, first, the spectrum and influence of hypoplasia of the left heart in neonatal coarctation, second, if the previously described critical values for adequacy of the left heart in neonates with critical aortic stenosis are applicable to neonates with coarctation, and, third, if any of the variables or associated abnormalities are risk factors for recoarctation, we studied 63 neonates who underwent repair of coarctation. From the initial echocar diogram, we measured multiple structures in the left heart, and calculated a score for adequacy as has been done for critical aortic stenosis. The sizes were compared to previously reported minimal values. We then analyzed the influence of the variables and the associated anomalies on outcome. There were no deaths. There was a broad spectrum of sizes that did not correlate with the need for re-intervention. The calculated score for adequacy would have predicted survival in only 56% of the patients, and 73% of the neonates had at least one parameter measured in the left heart below the previously reported minimal values. There is, therefore, a broad spectrum of sizes for the left heart in neonates with aortic coarctation that is not predictive of outcome. Minimal sizes, and the score for adequacy used for critical aortic stenosis, are not applicable to neonates with coarctation.

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Corresponding author

Llyod Y Tani, M D, Division of Cardiology Primary Children's Medical Center, 100 N. Medical Drive, Salt Lake City, Utah 84113 Tel 801–588–2600; Fax: 801–588–2612; E-mail pclrani@ihc.com

References

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1.Norwood, WI, Lang, P, Castaneda, AR, Campbell, DN. Experience with operations for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 1981; 82: 511519.
2.Bailey, L, Concepcion, W, Shattuck, H, Huang, L. Method of heart transplantation for treatment of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 1986; 92: 15.
3.Rhodes, LA, Colan, SD, Perry, SB, Jonas, RA, Sanders, SP. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991; 84: 23252335.
4.Leung, MP, McKay, R, Smith, A, Anderson, RH, Arnold, R. Critical aorric stenosis in early infancy. Anatomic and echocar diographic substrates of successful open valvotomy. J Thorac Cardiovasc Surg 1991, 101: 526535.
5.Pelech, AN, Dyck, JD, Trusler, GA, Williams, WG, Olley, PM, Rowe, RD, Freedom, RM. Critical aortic stenosis. J Thorac Cardiovasc Surg 1987; 94: 510517.
6.Latson, LA, Cheatham, JP, Gurgesell, HP, Relation of the echocardiographic estimate of left ventricular size to mortality in infants with severe left ventricular outflow obstruction. Am J Cardiol 1981; 48: 887891.
7.Parsons, MK, Moreau, GA, Graham, TP Jr, Johns, JA, Boucek, RJ. Echocardiographic estimation of critical left ventricular size in infants with isolated aortic valve stenosis. J Am Coil Cardiol 1991; 18: 10497ndash;1055.
8.Hammon, JW Jr, Lupinetti, FM, Maples, MD, Merrill, WH, Frist, WH, Graham, TP Jr, Bender, HW Jr. Predictors of operative mortality in critical valvular aortic stenosis presenting in infancy. Ann Thorac Surg 1988; 45: 537540.
9.Mocellin, R, Sauer, U, Simon, B, Comazzi, M, Sebening, F, Buhlmeyer, K. Reduced left ventricular size and endocardial fibroelastosis as correlates of mortality in newborns and young infants with severe aortic valve stenosis. Pediatr Cardiol 1983; 4: 265272.
10.lannettoni, MD, Bove, EL, Mosca, RS, Lupinetti, FM, Dorostkar, PC, Ludomirsky, A, Crowley, DC, Kulik, TJ, Rosenthal, A. Improving results with first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 1994; 107: 934940.
11.Page, DA, Levine, MM. Left ventricular growth in a patient with critical coarctation of the aorta and hypoplastic left ventricle. PediatrCardiol 1995; 16: 176178.
12.Minich, LL, Tani, LY, Hawkins, JA, Shaddy, RE. Possibility of postnatal left ventricular growth in selected infants with non- apex-forming left ventricles. Am Heart J 1997; 133: 570574.
13.Alboliras, ET, Pahl, E, Gidding, SS, Backer, CL, Rocchini, AP, Mavroudis, C. Very small left ventricles can grow. Circulation 1996; 94: 1297 (abstr).
14.Conte, S, Lacour-Gayet, F, Serraf, A, Sousa-Uva, M, Bruniaux, J, Touchot, A, Planché, C. Surgical management of neonatal coarctation. J Thorac Cardiovasc Surg 1995; 109: 663675.
15.Kron, IL, Flanagan, TL, Rheuban, KS, Carpenter, MA, Gutgesell, HP Jr, Blackbourne, LH, Nolan, SP. Incidence and risk of rein tervention after coarctation repair. Ann Thorac Surg 1990; 49: 920926.
16.Quaegebeur, JM, Jonas, BA, Weinberg, AD, Blackstone, EH, Kirklin, JWand the Congenital Heart Surgeons Society. Outcomes in seriously ill neonates with coarctation of the aorta. A multiinstitutional study. J Thorac Cardiovasc Surg 1994; 108: 841854.
17.Hijazi, ZM, Fahey, JT, Kleinman, CS, Hellenbrand, WE. Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results. Circulation 1991; 84: 11501156.
18.Merrill, WH, Hoff, SJ, Stewart, JR, Elkins, CC, Graham, TP Jr, Bender, HW Jr. Operative risk factors and durability of repair of coarctation of the aorta in the neonate. Ann Thorac Surg 1994; 58: 399403.
19.van Son, JAM, Phoon, CK, Silverman, NH, Haas, GS. Predicting feasibility of biventricular repair of right-dominant unbalanced atrioventricular canal. Ann Thorac Surg 1997 63: 16571663.
20.Tchervenkov, CI, Tahta, SA, Jutras, LC, Björkland, MJ. Biventricular repair in neonates with hypoplastic left heart complex. Ann Thorac Surg 1998; 66: 13501357.
21.Blaufox, AD, Lai, WW, Lopez, L, Nguyen, K, Griepp, RB, Parness, IA. Survival in neonateal biventricular repair of left-sided cardiac obstructive lesions associated with hypoplastic left ventricle. Am J Cardiol 1998; 82: 11381140.
22.Serraf, A, Piot, JD, Bonnet, N, Lacour-Gayet, F, Touchot, A, Bruniaux, J, Belli, E, Galletti, L, Planché, C. Biventricular repair approach in ducto-dependent neonates with hypoplastic but morphologically normal left ventricle. J Am Coil Cardiol 1999; 33: 827834.
23.Graham, TP JrAtwood, GF, Boerth, RC, Boucek, RJ, Smith, CW. Right and left heart size and function in infants with sympto matic coarctation. Circulation 1977; 56: 641647.

Keywords

Spectrum and influence of hypoplasia of the left heart in Neonatal aortic coarctation

  • Lloyd Y. Tani (a1), L. Luann Minich (a1), John A. Hawkins (a2), Edwin C. McGough (a2), Luciana T. Pagotto (a1), Garth S. Orsmond (a1) and Robert E. Shaddy (a1)...

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