The Anatomical or Functional Borderline Left Ventricle and Strategies for Staged Rehabilitation
The concept of the “borderline left heart” was introduced following the experience with fetal catheter interventions that aimed to change the natural history of critical aortic stenosis in the fetus. Early attempts to rescue the severely obstructed left ventricle during mid-gestation by transuterine, balloon aortic valvotomy yielded encouraging results in some, with progressive recovery of left ventricle (LV) contractile function in the fetus and associated continued growth of the LV cavity as gestation progressed [1, 2]. However, in about 60 % of these patients, LV growth was inadequate, and at birth, the LV was deemed incapable of supporting the systemic circulation. The constellation of anatomic features varied from that seen in young infants with Shone’s syndrome with mitral and aortic valve stenosis and coarctation to that of hypoplastic left heart syndrome. These features included mitral valve stenosis and hypoplasia, aortic valve stenosis, and varying degrees of endocardial fibroelastosis. The latter appeared to develop in utero and we theorized that its presence restricted LV growth in utero and postnatally.
KeywordsLeft Ventricle Aortic Valve Hypoplastic Left Heart Syndrome Aortic Valve Stenosis Interatrial Communication
- 2.Freud LR, McElhinney DB, Marshall AC, et al. Fetal aortic valvuloplasty for evolving hypoplastic left heart syndrome postnatal outcomes of the first 100 patients. Prenat Diagn. 2014;31:695–8.Google Scholar