Biventricular Conversion in the Borderline Hypoplastic Heart

  • PDF / 1,601,215 Bytes
  • 9 Pages / 595.276 x 790.866 pts Page_size
  • 40 Downloads / 172 Views

DOWNLOAD

REPORT


CONGENITAL HEART DISEASE (RA KRASUSKI AND G FLEMING, SECTION EDITORS)

Biventricular Conversion in the Borderline Hypoplastic Heart Nicholas D. Andersen 1,2 & Jacob C. Scherba 1,2 & Joseph W. Turek 1,2

# Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract Purpose of Review The development of biventricular repair and conversion pathways for patients with borderline hypoplastic heart disease represents an area of recent inquiry and innovation. This review summarizes emerging techniques and novel treatment algorithms for borderline hypoplastic heart disease with a focus on surgical advances within the last 10 years. Recent Findings Many patients with borderline hypoplastic heart disease are amenable to primary biventricular repair, or biventricular conversion following single-ventricle palliation coupled with ventricular rehabilitation strategies. New insights into the potential for growth and recovery of borderline ventricles have been uncovered. However, questions remain regarding optimal patient selection and the long-term outcomes of select patient groups treated with single-ventricle palliation versus biventricular repair/conversion or transplantation. Summary Efforts to direct a greater proportion of borderline hypoplastic heart patients towards a biventricular circulation are accelerating and represent important avenues for progress and future research in the field of congenital heart disease. Keywords Congenital heart surgery . Biventricular conversion . Biventricular repair . Ventricular rehabilitation . Hypoplastic left heart syndrome

Introduction Single-ventricle palliation culminating in the Fontan operation remains the primary therapy for patients born with functionally univentricular heart defects. Although the surgical outcomes of single-ventricle palliation have steadily improved over time, the unfortunate truth is that the Fontan circulation represents a grossly abnormal circulatory configuration which leads to a myriad of progressive, debilitating, and ultimately fatal medical problems that accumulate with time. However, a This article is part of the Topical Collection on Congenital Heart Disease

considerable subset of patients historically targeted for singleventricle palliation possess small, but potentially salvageable, ventricles that may be capable of supporting a biventricular circulation. Recent advances in the last 10 years are challenging past paradigms and allowing for a greater proportion of patients with “borderline” ventricles to achieve a twoventricle circulation, potentially avoiding the morbidity associated with long-term exposure to a single-ventricle circulation. This review discusses contemporary evaluation and treatment of children born with borderline hypoplastic heart disease and reviews advances in surgical technique, patient management, and results with biventricular repair, ventricular recruitment, and biventricular conversion treatment pathways.

* Nicholas D. Andersen [email protected] Jacob C. Scherba [email protected]

Defining th