Borderline left ventricular hypoplasia without significant aortic or mitral stenosis: Cardiac magnetic resonance criteria for biventricular repair

Aswathy Vaikom House; Aakansha Singh; Ankavipar Sapruangrang; Edgar Jaeggi; David J Barron; Christopher Z Lam; Shi-Joon Yoo

doi:10.1093/ejcts/ezaf203

Borderline left ventricular hypoplasia without significant aortic or mitral stenosis: Cardiac magnetic resonance criteria for biventricular repair

Eur J Cardiothorac Surg. 2025 Jun 19:ezaf203. doi: 10.1093/ejcts/ezaf203. Online ahead of print.

Authors

Aswathy Vaikom House¹, Aakansha Singh¹, Ankavipar Sapruangrang¹, Edgar Jaeggi¹, David J Barron², Christopher Z Lam^{1

3}, Shi-Joon Yoo^{1

3}

Affiliations

¹ Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, Toronto, Canada.
² Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Canada.
³ Department of Diagnostic & Interventional Radiology, Hospital for Sick Children, Toronto, Canada.

PMID: 40578314
DOI: 10.1093/ejcts/ezaf203

Abstract

Objectives: Bi-ventricular (Bi-V) repair is viable in some patients with borderline left ventricular (LV) hypoplasia. We aimed to identify cardiovascular magnetic resonance (CMR) criteria predictive of successful primary Bi-V repair in neonates with borderline LV hypoplasia without significant mitral valve (MV) & aortic valve (AV) stenosis.

Methods: Retrospective study (2003-2024) of patients with borderline LV hypoplasia with CMR for decision-making. Patients MV stenosis (mean Doppler gradient > 5 mmHg) and/or AV stenosis (peak Doppler gradient > 20 mmHg) were excluded. Patients divided into 2 groups: primary Bi-V repair and hybrid procedure. Outcomes categorized as successful primary Bi-V repair, successful staged Bi-V repair and failure to achieve Bi-V repair.

Results: 23/37 patients (62%) underwent successful primary Bi-V repair, 8/37 (22%) underwent staged Bi-V repair, and 6/37 (16%) failed to achieve Bi-V repair. The successful primary/staged Bi-V repair group had higher LVEDVi (p < 0.002), higher blood flow volume through the ascending aorta (p < 0.012), and higher QAo/superior vena cava (QSVC) flow ratio (p = 0.034) compared to failure to achieve Bi-V repair group. CMR LVEDVi cutoff of 27 mL/m2 had 87% sensitivity and 79% specificity (AUC 87.6%), and QAo threshold of 1.9 L/min/m2 had 65.2% sensitivity and 92.9% specificity (AUC 86.0%) for predicting successful primary Bi-V repair. 7/31(22%) patients with Bi-V repair underwent reinterventions for LVOT obstruction & MV stenosis.

Conclusions: In patients with borderline LV hypoplasia without MV/AV stenosis CMR LVEDVi > 27 mL/m2 & QAo> 1.99 L/min/m2 were prognostic for successful primary biventricular repair.

Keywords: Bi-Ventricular repair; Borderline left ventricle; Hypoplastic left heart complex; Single ventricle palliation.

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