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Anderson RH, Spicer DE, Crucean A. What Is the Hypoplastic Left Heart Syndrome? World J Pediatr Congenit Heart Surg 2024; 15:397-399. [PMID: 38477687 DOI: 10.1177/21501351241232074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Affiliation(s)
| | - Diane E Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Adrian Crucean
- Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's Hospital, Birmingham, UK
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Loeffelbein F, Wronski L, Riede FT. Echocardiography: conotruncal anomaly: a case of common arterial trunk with intact ventricular septum and hypoplastic left heart complex with unbalanced pulmonary stenoses. Cardiol Young 2023; 33:2676-2677. [PMID: 37850484 DOI: 10.1017/s1047951123003554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
We describe the echocardiographic findings of a common arterial trunk with intact ventricular septum, mitral and left ventricular hypoplasia, atretic left ventricular outlet and bilateral, and unbalanced pulmonary artery stenoses.
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Affiliation(s)
- Florian Loeffelbein
- University Hospital of Pediatric Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - Lena Wronski
- Department of Neonatology, University Hospital Leipzig, Leipzig, Germany
| | - Frank-Thomas Riede
- University Hospital of Pediatric Cardiology, Heart Center Leipzig, Leipzig, Germany
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Anderson RH, Spicer DE, Crucean A. Which Phenotypes Should We Include in the Hypoplastic Left Heart Syndrome? World J Pediatr Congenit Heart Surg 2023; 14:738-740. [PMID: 37738500 PMCID: PMC10631272 DOI: 10.1177/21501351231181313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/18/2023] [Indexed: 09/24/2023]
Abstract
The recent special issue of the World Journal for Pediatric and Congenital Heart Surgery devoted to hypoplastic left heart syndrome, and its related anomalies, contained significant information of great clinical relevance. Very little attention, however, was devoted to the integrity of ventricular septum as providing a criterion to distinguish between the phenotypes to be included within the syndrome, as opposed to the related anomalies. In this commentary, we summarize the evidence in support of the notion that the phenotypes to be included within the syndrome can be interpreted on the basis of an acquired disease of fetal life. We suggest that it is the integrity of the ventricular septum that provided the major criterion for the distinction between the lesions making up the syndrome and the related anomalies. The subsets of lesions to be included within the syndrome can then be recognized in terms of the time, subsequent to the closure of the embryonic interventricular communication, at which the left ventricle ceased its growth relative to the remainder of the cardiac components. On this basis, it is possible to recognize the combinations of aortic and mitral atresia, mitral stenosis with aortic atresia, combined mitral and aortic stenosis, and hypoplasia of the left ventricle with commensurate hypoplasia of the aortic and mitral valves; the latter combination now recognized as the hypoplastic left heart complex.
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Affiliation(s)
| | - Diane E. Spicer
- Heart Institute, Johns Hopkins All Children's Hospital, St. Petersberg, FL, USA
| | - Adrian Crucean
- Department of Paediatric Cardiac Surgery, Birmingham Women's and Children's Hospital, Birmingham, UK
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Jacobs JP. Hypoplastic Left Ventricle: Definition, Morphology, and Classification of the Cardiac Phenotypes. World J Pediatr Congenit Heart Surg 2022; 13:615-619. [PMID: 36053100 DOI: 10.1177/21501351221114775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A prior manuscript provided information about hypoplastic left heart syndrome (HLHS) and related malformations, including definitions, morphology, and classification, based on the 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). This manuscript provides information about the related cardiac phenotypes associated with "hypoplastic left ventricle" that might be suitable for biventricular repair, including definitions, morphology, and classification of the cardiac phenotypes of the following four congenital cardiac malformations that can all include a hypoplastic left ventricle: (1) hypoplastic left heart complex (HLHC), (2) critical aortic stenosis with left ventricular hypoplasia, (3) aortic atresia + ventricular septal defect, and (4) hypoplastic left ventricle with severely unbalanced atrioventricular septal defect.
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Affiliation(s)
- Jeffrey P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, FL, USA
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Haberer K, Fruitman D, Power A, Hornberger LK, Eckersley L. Fetal echocardiographic predictors of biventricular circulation in hypoplastic left heart complex. Ultrasound Obstet Gynecol 2021; 58:405-410. [PMID: 33270293 DOI: 10.1002/uog.23558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/01/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To determine which echocardiographic features of hypoplastic left heart complex (HLHC) in the fetal period are predictive of biventricular (BV) circulation and to evaluate the long-term outcome of patients with HLHC, including rates of mortality, reintervention and development of further cardiac disease. METHODS Echocardiograms of fetuses with HLHC obtained at 18-26 weeks and 27-36 weeks' gestation between 2004 and 2017 were included in the analysis. The primary outcome was successful BV circulation (Group 1). Group 2 included patients with single-ventricle palliation, death or transplant. Univariate analysis was performed on data obtained at 18-26 and 27-36 weeks and multivariate logistic regression was performed on data obtained at 27-36 weeks only. RESULTS Of the 51 included cases, 44 achieved successful BV circulation (Group 1) and seven did not (Group 2). Right-to-left/bidirectional foramen ovale (FO) flow and a higher mitral valve (MV) annulus Z-score were associated with successful BV circulation on both univariate and multivariate analysis. Bidirectional or left-to-right FO flow, left ventricular length (LVL) Z-score of < -2.4 and a MV Z-score of < -4.5 correctly predicted 80% of Group 2 cases. Late follow-up was available for 41 patients. There were two late deaths in Group 2. Thirteen patients in Group 1 required reintervention, 12 developed mitral stenosis and five developed isolated subaortic stenosis. CONCLUSIONS BV circulation is common in fetuses with HLHC. Higher MV annulus and LVL Z-scores and right to left direction of FO flow are important predictors of BV circulation. Long-term sequelae in those with BV circulation may include mitral and subaortic stenosis. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K Haberer
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - D Fruitman
- Department of Pediatrics, Section of Cardiology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - A Power
- Department of Pediatrics, Section of Cardiology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - L K Hornberger
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
- Department of Obstetrics & Gynecology, Lois Hole Women's Hospital, Royal Alexandra Hospital, Edmonton, Alberta, Canada
- Women's & Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - L Eckersley
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
- Women's & Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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Alhuzaimi AN. Case report: duct dependency in hypoplastic left heart complex can be reversible without surgery. Cardiol Young 2021; 31:325-8. [PMID: 33185173 DOI: 10.1017/S1047951120003935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We describe an infant with duct-dependent hypoplastic left heart complex with moderate hypoplasia of the left ventricle and aortic arch who was not operated due to resource limitations. The left-sided structures grew remarkably due to favourable loading condition changes of the left ventricle, allowing weaning from prostaglandin at the age of 3 months and discharging the patient without intervention.
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Schranz D, Bauer A, Reich B, Steinbrenner B, Recla S, Schmidt D, Apitz C, Thul J, Valeske K, Bauer J, Müller M, Jux C, Michel-Behnke I, Akintürk H. Fifteen-year single center experience with the "Giessen Hybrid" approach for hypoplastic left heart and variants: current strategies and outcomes. Pediatr Cardiol 2015; 36:365-73. [PMID: 25179460 PMCID: PMC4303711 DOI: 10.1007/s00246-014-1015-2] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/22/2014] [Indexed: 11/28/2022]
Abstract
Presented is a retrospective outcome study of a 15-year single institutional experience with a contemporary cohort of patients with hypoplastic left heart syndrome and complex that underwent a "Giessen Hybrid" stage I as initial palliation. Hybrid approach consisting of surgical bilateral pulmonary artery banding and percutaneous duct stenting with or without atrial septum manipulation was developed from a rescue approach to a first-line procedure. Comprehensive Aristotle score defined pre-operative condition. Fifteen-year follow-up mortality is reported as occurring within the staged univentricular palliation or before and after biventricular repair. Hybrid stage I was performed in 154 patients; 107 should be treated by single ventricle palliation, 33 by biventricular repair (BVR), 7 received heart transplantation, and 7 were treated by comfort care, respectively. Overall 34 children died. The Aristotle score (mean value 18.2 ± 3) classified for univentricular circulations in newborns did not have statistical impact on the outcome. Two patients died during stage I (1.2%), and the interstage I mortality was 6.7%, and stage II mortality 9%, respectively. Stage III was up to now performed in 57 patients without mortality. At 1 year, the overall unadjusted survival of HLHS and variants was 84% and following BVR 89%, respectively. The Fifteen-year survival rate for HLHS and variants was 77%, with no significant impact of birth weight of less than 2.5 kg. In conclusion, Hybrid stage I fulfilled the criteria of life-saving approach. In our institution, Hybrid procedure replaced Norwood-staged palliation with a considerable mid- and long-term survival rate. Considering interstage mortality close surveillance is mandatory.
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Affiliation(s)
- Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385, Giessen, Germany,
| | - Anna Bauer
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Bettina Reich
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Blanka Steinbrenner
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Sabine Recla
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Dorle Schmidt
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Christian Apitz
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Josef Thul
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Klaus Valeske
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Jürgen Bauer
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Matthias Müller
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Christian Jux
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Ina Michel-Behnke
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
| | - Hakan Akintürk
- Pediatric Heart Center, Justus-Liebig University, Feulgenstr. 12, 30385 Giessen, Germany
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Kohl T. Chronic intermittent materno-fetal hyperoxygenation in late gestation may improve on hypoplastic cardiovascular structures associated with cardiac malformations in human fetuses. Pediatr Cardiol 2010; 31:250-63. [PMID: 20024652 PMCID: PMC2817075 DOI: 10.1007/s00246-009-9600-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 11/04/2009] [Indexed: 11/10/2022]
Abstract
Hypoplasia of cardiovascular structures is a common finding in fetuses with cardiac malformations. Materno-fetal hyperoxygenation (HO) during late gestation promotes venous return to the fetal heart. This analysis in human fetuses sought to define whether this "loading" effect might improve hypoplastic cardiovascular dimensions. Fifteen late-gestation fetuses presented with varying degrees of hypoplastic cardiovascular structures. In these cases, chronic intermittent materno-fetal HO was administered during periods ranging from 8 to 33 days. Cardiac measurements were taken before and at the end of treatment and translated into Z-scores as well as plotted on normal growth charts. During the treatment period, chronic intermittent materno-fetal HO was associated with improved dimensions of >or=1 hypoplastic cardiovascular structures in most fetuses. However, in some cases, the effect of HO was neutralized or impaired by the presence of ventricular septal defects as well as obstructions to ventricular filling or emptying. Chronic intermittent materno-fetal HO near term may be associated with improvements of hypoplastic cardiovascular dimensions in fetuses with a spectrum of cardiac malformations. This effect may facilitate postnatal treatment and improve prognosis in suitable cases.
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Affiliation(s)
- Thomas Kohl
- German Center for Fetal Surgery and Minimally Invasive Therapy, University Hospital of Bonn, Bonn 53105, Germany.
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