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Characterising adequacy or inadequacy of the borderline left ventricle: what tools can we use?*

Published online by Cambridge University Press:  16 December 2015

Michelle Kaplinski  and
Meryl S. Cohen
Michelle Kaplinski
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
Meryl S. Cohen*
Affiliation:
Division of Cardiology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
*
Correspondence to: Meryl S. Cohen, MD, Professor of Pediatrics, Division of Cardiology, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd. Philadelphia, PA 19104, United States of America. Tel: +2155903354; Fax: +2155903788; E-mail: cohenm@email.chop.edu
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Abstract

Borderline left ventricle refers to a spectrum of left ventricular underdevelopment, typically associated with other cardiac anomalies. The left ventricle may be mildly hypoplastic, as is sometimes seen accompanying aortic coarctation, or it can be severely hypoplastic, as is seen in hypoplastic left heart syndrome. For patients with a borderline left ventricle that is at either extreme, the treatment decision is relatively straightforward. Those with the most severe form of left ventricle hypoplasia will require single ventricle palliation or cardiac transplantation, whereas those with the mildest form may not need any intervention. It is the management strategy of children that fall within the grey zone of the spectrum, which continues to be controversial and remains variable within and among different institutions. Cardiac diseases with associated left ventricle hypoplasia include critical aortic stenosis, mitral stenosis, coarctation of the aorta, arch hypoplasia, cor triatriatum, unbalanced common atrioventricular canal, Shone’s complex, total anomalous pulmonary venous return, and complex conotruncal abnormalities. In this review, we will discuss the assessment and management of infants with borderline left ventricle with critical aortic stenosis or arch obstruction and associated mitral anomalies.

Keywords

Left ventricular hypoplasiacritical aortic stenosisaortic arch hypoplasiaendocardial fibroelastosismitral stenosis
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 8: HeartWeek 2015 , December 2015 , pp. 1482 - 1488
Copyright
© Cambridge University Press 2015 

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Footnotes

*

Presented at the Children’s Hospital of Philadelphia Cardiology 2015: 18th Annual Update on Pediatric and Congenital Cardiovascular Disease: “Challenges and Dilemmas”, Scottsdale, Arizona, United States of America, Wednesday February 11, 2015–Sunday, February 15, 2015.

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