Growing the Borderline Hypoplastic Left Ventricle: Hybrid Approach

Surgical management of patients with borderline left ventricular dimensions requires adequate patient selection. Therapeutic concepts have emerged to promote left ventricular growth and achieve adequate dimensions for staged biventricular repair. The hybrid approach thereby uses bilateral pulmonary artery banding and ductal stenting for initial palliation. A restrictive atrial septum is usually left unaddressed to ensure antegrade left ventricular filling. Final repair focuses on relief of obstructive left-sided lesions such as mitral valve stenosis, endocardial fibroelastosis, aortic valve stenosis, and aortic arch obstruction. The initial hybrid procedure is less traumatic than primary relief of left-sided obstructions. It remains to be determined if early or delayed relief of obstructive lesions improves the chances to grow left-sided structures.