Borderline Hypoplastic Left Heart Malformations: Norwood Palliation or Two-Ventricle Repair?

S. H. Daebritz; A. R. Tiete; D. Rassoulian; U. Roemer; R. Kozlik-Feldmann; J. S. Sachweh; H. Netz; B. Reichart

doi:10.1055/s-2002-34580

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2002; 50(5): 266-270
DOI: 10.1055/s-2002-34580

Original Cardiovascular

Original Paper
© Georg Thieme Verlag Stuttgart · New York

Borderline Hypoplastic Left Heart Malformations: Norwood Palliation or Two-Ventricle Repair?

S. H. Daebritz¹ , A. R. Tiete¹ , D. Rassoulian¹ , U. Roemer² , R. Kozlik-Feldmann² , J. S. Sachweh¹ , H. Netz² , B. Reichart¹

¹Clinic of Cardiac Surgery, University Hospital Grosshadern, Munich
²Department of Pediatric Cardiology and Intensive Care, University Hospital Grosshadern, Munich

Abstract

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Abstract

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 20mmHg (patient 3). Clinical condition of all survivors in both groups is good. Conclusion: 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.

Key words

Cardiac surgery - Congenital heart disease - Hypoplastic left heart syndrome - Two-ventricle repair

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MD Sabine Daebritz

Department of Cardiac Surgery, University Hospital Grosshadern

Marchioninistr. 15

81377 Munich

Germany

Phone: ++49-89-7095-3941

Fax: ++49-89-7095-3943

Email: Sdaebritz@aol.com