Analysis of potential anatomic or physiologic determinants of outcome of palliative surgery for hypoplastic left heart syndrome.

Sixty-five consecutive patients with hypoplastic left heart syndrome underwent preoperative two-dimensional echocardiographic examination (and Doppler examinations in 33) to assess parameters potentially predictive of early (less than or equal to 30 days) mortality after palliative surgery. The six anatomic and physiologic factors considered were right ventricular wall thickness, right ventricular shortening, tricuspid (or common atrioventricular valve) regurgitation, ascending aortic size, distal aortic arch anatomy, and atrial septal anatomy. Right ventricular wall thickness was 3 or 4 mm in 59 of 65 patients and did not correlate with outcome. There was no significant difference in early mortality between patients with abnormal right ventricular shortening (11 of 23 patients [48%]) and those with normal right ventricular shortening (19 of 42 patients [45%]). Tricuspid or common atrioventricular valve regurgitation was found in 15 of 33 patients and eight of these suffered early death (53%) compared with six (33%) among the 18 patients without atrioventricular valve regurgitation. Ascending aortic diameter ranged from 2 to 6 mm and did not correlate with early outcome. Coarctation of the aorta, found in 18 of 54 patients (33%), and leftward displacement of the superior attachment of septum primum, noted in 33 of 63 patients (52%), likewise did not correlate with outcome. Therefore, at present, variations in the six parameters analyzed cannot be considered contraindications to palliative surgery in patients with hypoplastic left heart syndrome.