Determining Biventricular Repair Feasibility in Children with Dominant Right Ventricle Using Left Ventricular Quality Measured on Cardiac Computed Tomography

TL;DR

This study identifies a minimum threshold for left ventricular quality on CT scans to determine if biventricular repair is feasible in children with a dominant right ventricle.

Contribution

The study establishes specific thresholds for left ventricular quality measurements that predict successful biventricular repair in children with a dominant right ventricle.

Findings

Height-adjusted normal reference curves for LV measurements were created using healthy controls.

The lowest feasible LV quality thresholds for BiVR were 39.1% LVEDV, 49.0% LVMM, and 44.9% MAA.

LV quality in BiVR patients improved to the normal range during follow-up.

Abstract

Left-ventricular (LV) characteristic measurements are
crucial for evaluating the feasibility of biventricular repair (BiVR). This study
aimed to determine the threshold of LV quality on cardiac computed tomography
(CCT) for BiVR in children with a dominant right ventricle (DRV).

We retrospectively reviewed all children with a DRV who
underwent either BiVR or single ventricle palliation (SVP) at our institution
between 2003 and 2019 in a case-control study with healthy individuals.
Measurements including LV end-diastolic volume (LVEDV, mL), LV myocardial mass
(LVMM, gm), and mitral annulus area (MAA, cm2) were quantified using CCT.
The factor with the highest correlation with body size was used to adjust these
three measurements to derive normal references in the control group. The LV
quality of patients on each CCT measurement was represented as a percentage of
the normal reference data that we established. The feasible LV quality for BiVR
was defined as the lowest limit of all three LV measurements in one subject who
survived BiVR among our patients with DRVs.

The cohort
comprised 30 patients and 76 healthy controls. Height was the factor with the
highest correlation with all three LV measurements. Height-adjusted normal
reference curves and formulas were created. The mean LV quality in surviving
patients who underwent BiVR was better than that in those who underwent SVP. The
lowest limits for LV quality in one survivor of BiVR were 39.1% LVEDV, 49.0%
LVMM, and 44.9% MAA. During follow up, the LV quality of patients who received
BiVR shifted to the normal range.

LV quality should be at least
greater than 45% of normal values to promise survival in patients with DRVs who
are being considered for a BiVR.

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