Hypoplastic left heart complex with “borderline left ventricle” and intact ventricular
septum is a clinical conundrum for the congenital heart surgeon. The choice between
neonatal biventricular repair and single ventricle palliation can be challenging,
and the current tools to aid in the decision-making process fail to account for the
morbidity associated with intermediate and late diastolic dysfunction. Staged ventricular
recruitment, consisting of valvular repair techniques, resection of endocardial fibroelastosis,
atrial septal restriction, and augmentation of pulmonary blood flow, has been shown
to improve left ventricular size and function culminating in eventual biventricular
circulation. Despite staged ventricular recruitment, some patients cannot undergo
biventricular conversion. Strategies to address these complex patients, including
the “reverse” double switch, are the next frontier in biventricular repair.
Keywords
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