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Spectrum and influence of hypoplasia of the left heart in Neonatal aortic coarctation

Published online by Cambridge University Press:  19 August 2008

Lloyd Y. Tani ,
L. Luann Minich ,
John A. Hawkins ,
Edwin C. McGough ,
Luciana T. Pagotto ,
Garth S. Orsmond  and
Robert E. Shaddy
Lloyd Y. Tani*
Affiliation:
Department of Pediatrics, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah, USA
L. Luann Minich
Affiliation:
Department of Pediatrics, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah, USA
John A. Hawkins
Affiliation:
Department of Cardiovascular Surgery, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah, USA
Edwin C. McGough
Affiliation:
Department of Cardiovascular Surgery, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah, USA
Luciana T. Pagotto
Affiliation:
Department of Pediatrics, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah, USA
Garth S. Orsmond
Affiliation:
Department of Pediatrics, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah, USA
Robert E. Shaddy
Affiliation:
Department of Pediatrics, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah, USA
*
Llyod Y Tani, M D, Division of Cardiology Primary Children's Medical Center, 100 N. Medical Drive, Salt Lake City, Utah 84113 Tel 801–588–2600; Fax: 801–588–2612; E-mail pclrani@ihc.com
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Abstract

Obstruction of the left ventricular outflow tract may be associated with hypoplasia of the left heart, which importantly influences the options for treatment. Although the influence of the size of the left heart on the outcome for critical aortic stenosis has been described, less is known about the spectrum of such hypoplasia seen with neonatal aortic coarctation, and how this influences outcome. To determine, first, the spectrum and influence of hypoplasia of the left heart in neonatal coarctation, second, if the previously described critical values for adequacy of the left heart in neonates with critical aortic stenosis are applicable to neonates with coarctation, and, third, if any of the variables or associated abnormalities are risk factors for recoarctation, we studied 63 neonates who underwent repair of coarctation. From the initial echocar diogram, we measured multiple structures in the left heart, and calculated a score for adequacy as has been done for critical aortic stenosis. The sizes were compared to previously reported minimal values. We then analyzed the influence of the variables and the associated anomalies on outcome. There were no deaths. There was a broad spectrum of sizes that did not correlate with the need for re-intervention. The calculated score for adequacy would have predicted survival in only 56% of the patients, and 73% of the neonates had at least one parameter measured in the left heart below the previously reported minimal values. There is, therefore, a broad spectrum of sizes for the left heart in neonates with aortic coarctation that is not predictive of outcome. Minimal sizes, and the score for adequacy used for critical aortic stenosis, are not applicable to neonates with coarctation.

Keywords

Coarctation of the aortahypoplastic left heart
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 2 , March 2000 , pp. 90 - 97
Copyright
Copyright © Cambridge University Press 2000

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