Hypoplastic left heart syndrome: Hemodynamic and angiographic assessment after initial reconstructive surgery and relevance to modified fontan procedure

• Published in: Journal of the American College of Cardiology 1991-04, Vol.17 (5), p.1143-1149
• Main Authors: Chang, Anthony C., Farrell, Paul E., Murdison, Kenneth A., Baffa, Jeanne M., Barber, Gerald, Norwood, William I., Murphy, John D.
• Format: Article
• Language: English
• Subjects: Aorta, Thoracic - diagnostic imaging; Biological and medical sciences; Cardiac Catheterization; Cardiology. Vascular system; Child, Preschool; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Female; Heart; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - mortality; Heart Defects, Congenital - physiopathology; Heart Defects, Congenital - surgery; Hemodynamics - physiology; Humans; Infant; Male; Medical sciences; Pulmonary Artery - physiology; Radiography; Risk Factors; Survival Rate; Tricuspid Valve - diagnostic imaging; Vascular Resistance; Ventricular Function, Right - physiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(91)90845-Z

After undergoing initial reconstructive surgery for hypoplastic left heart syndrome performed between August 1985 and March 1989, 59 patients (age range 3 to 27 months, mean 13.8 ± 4.5) underwent elective cardiac catheterization in anticipation of a modified Fontan procedure. Five important hemodynamic and anatomic features considered to be components or successful reconstructive surgery were specifically addressed. 1) Interatrialcommunication: Only two patients had a measured pressure difference of >4 mm Hg across the atrial septum. 2) Tricuspid valve function:Angiography demonstrated significant tricuspid valve regurgitation in only five patients (moderate in two and severe in three). 3) Aortic arch:Pressure tracings from the right ventricle to the descending aorta revealed a gradient >25 mm Hg in only two patients. 4) Pulmonary vasculatare:Ten patients had a calculated pulmonary vascular resistance >4 U · m2; 51 (86%) of the 59 patients had no evidence of distortion (stenosis or hypoplasia) of either the left or the right pulmonary artery. 5) Right ventricular function:Five patients had an end-diastolic pressure in the right ventricle >12 mm Hg and two patients had qualitative assessment of decreased ventricular function. Comparison of catheterization data between survivors and nonsurvivors of the subsequent modified Fontan procedure showed that only significant tricuspid regurgitation is a possible predictor of poor outcome. After first stage reconstructive surgery for hypoplastic left heart syndrome, most survivors have favorable anatomy and hemodynamics at follow-up cardiac catheterization for a subsequent Fontan procedure.