Requirements for biventricular repair after bilateral pulmonary artery banding for patients with borderline left ventricle

Objective

The study objective was to examine factors associated with the decision to perform biventricular repair or univentricular repair in patients with left heart obstructive diseases after bilateral pulmonary artery banding.

Methods

In this retrospective study, we used data from an institutional database. In total, 12 patients who underwent univentricular repair (group U) and 18 patients who underwent biventricular repair (group B) were included in the analysis. Left heart obstructive diseases included critical aortic stenosis, coarctation complex, interruption of aortic arch, and hypoplastic left heart complex. The Z-scores of the mitral, aortic, tricuspid, and pulmonary valve diameters, along with other parameters, were compared before and after bilateral pulmonary artery banding. Three months after the initial bilateral pulmonary artery banding, a cardiac catheter examination was performed in all patients to determine whether univentricular repair or biventricular repair should be performed.

Results

Mitral valve size in group B was significantly larger than in group U both before (−0.27 ± 1.04 vs −2.25 ± 1.83, P < .01) and after bilateral pulmonary artery banding (0.05 ± 1.58 vs −1.86 ± 1.91, P < .01). In group U, mitral and aortic valve sizes showed no significant increase after bilateral pulmonary artery banding. In group B, mitral valve size showed no significant increase after bilateral pulmonary artery banding (−0.27 ± 1.04 vs 0.06 ± 1.58, P = .26), whereas aortic valve size demonstrated a significant increase (−4.33 ± 2.60 vs −3.13 ± 2.64, P = .02).

Conclusions

In cases of a “borderline” left ventricle, a large mitral valve from birth and growth of the aortic valve are crucial for successful biventricular repair. Three months after bilateral pulmonary artery banding is considered the appropriate time to decide the management course to be pursued.