Hemodynamic parameters predict adverse outcomes following biventricular conversion with single-ventricle palliation takedown

Abstract

Elevated preoperative LVEDP is a risk factor for suboptimal postoperative hemodynamic parameters and adverse outcome following BiV conversion from single-ventricle palliation.

How many types of circulation can a boy have during his life? A case of aortic stenosis with a borderline left ventricle

“…We decided to proceed with conversion to biventricular circulation despite an elevated LVEDP of 14 mm Hg. Patients with LVEDP ≥ 13 mm Hg have been shown to carry a high risk of unfavourable outcome after biventricular conversion 7 . Looking at the data retrospectively, staying with univentricular circulation and replacing the TCPC conduit to remove inter‐atrial obstruction would seem as a more secure choice.…”

“…The decision is usually made during newborn age, but conversion to biventricular is possible later if the LV grows enough. 7 In our patient, after an initial aortic valvuloplasty, univentricular circulation was chosen. Various LV scores calculated retrospectively would favour the same decision.…”

“…Elevated pulmonary vascular resistance can develop and make conversion back to univentricular impossible. The decision is usually made during newborn age, but conversion to biventricular is possible later if the LV grows enough 7 …”

From Fontan to Anatomical Repair 16 Years Later

“…At the same time, it may be interesting to identify the hemodynamic conditions preserving the potential for growth of the LV. 6,7 In the first case, LV postcharge was improved by coarctation repair, and thereafter the removal of the supravalvular membrane associated with the spontaneous restriction of the ventricular septal defect might have improved LV preload. But the MV and LV growth was slow and considered poor at 1 year of age before the Kawashima intervention.…”

Commentary: Diastolic dysfunction following biventricular conversion: When physiology beats anatomy

“…The Boston group has championed left ventricle recruitment and biventricular conversion strategies and has contributed a great deal to our knowledge related to this matter. [1][2][3] They introduced staged left ventricular recruitment to progressively increase left ventricle loading and they demonstrated subsequent growth allowing successful biventricular conversion. 1,2 They also demonstrated that although growth in size was necessary, it was not always enough for predicting successful biventricular conversion and that diastolic dysfunction was a major problem in some of those patients.…”