Borderline hypoplasia of the left ventricle in neonates: Insights for decision-making from functional assessment with magnetic resonance imaging

Abstract

Magnetic resonance imaging is feasible in neonates with borderline left ventricular hypoplasia. Echocardiography does not accurately measure left ventricular hypoplasia in these patients and may unfairly preclude some patients from a biventricular repair in whom magnetic resonance is reassuring.

Validation of 3D Echocardiographic Assessment of Left Ventricular Volumes, Mass, and Ejection Fraction in Neonates and Infants With Congenital Heart Disease

“…4,8 However, even when using risk stratification scores, deciding which ventricles will be able to perform systemic work continues to be problematic. 9 MRI summation of discs has been applied to measure LV volumes in these young patients.…”

“…9 MRI summation of discs has been applied to measure LV volumes in these young patients. 4 However, MRI scans may require general anesthesia, and in some instances mechanical venti-lation, and involve a series of breath holds that may be associated with hemodynamic compromise in some of these very ill infants.…”

“…1,2 LV volumes have and continue to be used as key determinants of suitability for 1-versus 2-ventricular repair. 3,4 To date, measurements have been based on 2D echocardiography, applying formulas that make inherent assumptions about LV geometry. However, in young pediatric patients with complex CHD, the LV is distorted and does not assume a typical ellipsoid shape, limiting the accuracy of 2D echocardiographic evaluation of mass and volumes.…”

Multimodality Noninvasive Imaging for Assessment of Congenital Heart Disease

“…Rarely, additional imaging using CMR is necessary to clarify details of intracardiac or extracardiac vascular anatomy, quantify ventricular volume for "borderline" sized ventricles, and to evaluate for the presence of endomyocardial fibroelastosis. 60,61 Diagnostic cardiac catheterization is rarely necessary in the newborn period. Traditionally, cardiac catheterization is performed before the cavopulmonary anastomosis and the Fontan operation.…”

The Functional Intraoperative Pulmonary Blood Flow Study Is a More Sensitive Predictor Than Preoperative Anatomy for Right Ventricular Pressure and Physiologic Tolerance of Ventricular Septal Defect Closure After Complete Unifocalization in Patients With Pulmonary Atresia, Ventricular Septal Defect, and Major Aortopulmonary Collaterals

“…For example, we recently showed that functional MRI-based flow studies allowed a biventricular repair in up to one-third of neonates with marginal-size left ventricles who might have otherwise undergone a single ventricle repair. 13 Although not perfect, functional data increase the accuracy and compress the confines of the marginal zone for binary decisions. The error rate for acute tolerances of VSD closure in this study was 5.2% (1/19), and the statistical predictive value of the flow study was 83%.…”