Objectives: In patients with varying degrees of left heart hypoplasia, it is often difficult to determine if the left heart structures are adequate in size to support a biventricular circulation. Historically, the decision to pursue a univentricular (UV) or biventricular (BV) repair needed to be made early and was often irreversible. We sought to determine if the Hybrid Procedure is a better initial approach in patients with left ventricles that are borderline in size.
Methods: We describe a series of four patients with various congenital malformations, all of whom had borderline left ventricles. Based on preoperative echocardiograms, several published scoring systems were used to predict whether UV or BV repair would be optimal.
Results: Calculations with three scoring systems were performed and left ventricular volume was calculated for each patient. 20 ml/m2 was used as the minimum cutoff value for adequacy of BV repair. The LV volumes for the patients were 17.1, 23.7, 25.4, and 25.8 ml/ m2. In none of the four patients were the calculations unanimous in the recommendation to pursue either a UV or BV repair. All four patients underwent the Hybrid Procedure and then eventual UV (2 patients) or BV (2 patients) repair. All four survived.
Conclusions: The Hybrid Procedure may be the best option in patients born with a borderline left ventricle. It can serve as a bridge to more definitive repair when patients are older, larger, and for whom the decision between UV and BV repair can be more easily made.