The hypoplastic left heart complex: fetal predictors of grow
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The terms “hypoplastic left heart complex” (HLHC) or borderline left heart have been used to describe fetuses with ventricular discrepancy involving small left heart structures but no overt valvar stenosis. Little evidence exists regarding predictors of successful biventricular (BV) repair in patients with HLHC.

Fetal echocardiograms performed between 2004?2017 with HLHC were included. Studies at 18–26?weeks and 27?37?weeks were analyzed. The primary outcome was a successful BV circulation (Group 1). Group 2 included patients with single ventricle palliation, death or transplant. Univariate analysis was performed on studies at 18?26?weeks and 27?37?weeks. Multivariate logistic regression was performed on studies between 27?37?weeks.

Of 51 included cases, 44 achieved a successful BV circulation (Group 1) and 7 did not (Group 2). On univariate analysis, right to left foramen ovale (FO) flow and a larger mitral valve (MV) annulus z score was associated with successful BV circulation. On multivariate analysis right to left FO flow and a higher MV z score were found in Group 1. Bidirectional or left to right FO flow, LV length (LVL) z score of less than ?2.4 and an MV z score of less than ?4.5 correctly predicted 80% of Group 2 outcomes. Late follow?up was available for 41 patients. There were two late deaths in Group 2. Thirteen patients in Group 1 required re?intervention, 12 developed mitral stenoses, and 5 developed isolated subaortic stenosis.

A successful BV circulation is common in fetuses with HLHC. The size of the MV annulus, the direction of FO flow, and LVL z score are important predictors of a successful BV circulation. Long term sequelae in those with a BV circulation may include mitral and subaortic stenosis