Surgical Palliation of Hypoplastic Left Side of the Heart

Abstract

Hypoplasia of the left side of the heart is the most common cause of death from heart disease in the first weeks of life and has heretofore been considered surgically unapproachable. Cardiac catheterization of a full-term infant in congestive heart failure at eight days of age revealed a hypoplastic left atrium, left ventricle and ascending aortic arch, without coarctation. Adequate mixing of oxygenated blood was provided through a large atrial septal defect while ventricular output was afforded via a right-to-left shunt through a still patent ductus arteriosus. Partial bypass of the left side of the heart was performed by anastomosis of the ascending aorta to the right pulmonary artery followed by banding of both pulmonary arteries distally. Signs of cardiac failure promptly abated, and the infant's status remained satisfactory six weeks after operation. Infants with clinical signs of this syndrome deserve detailed study to determine their suitability for similar palliative surgery.