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Abstract Background Most patients with significant left ventricular (LV) hypoplasia undergo single ventricle (SV) palliation, but biventricular (Bi-V) repair is viable in some patients with borderline LV hypoplasia. We sought to identify CMR (cardiovascular magnetic resonance) criteria predictive of successful primary Bi-V repair in neonates with borderline LV hypoplasia without significant stenosis of the mitral valve (MV) and aortic valve (AV), and to determine reasons for reintervention after successful Bi-V repair. Methods This retrospective study included all patients with borderline LV hypoplasia who underwent CMR from 2003-2024 for surgical decision-making. Patients with abnormal segmental connections, atrioventricular septal defects, unrestrictive ventricular septal defects, those with more than mild MV stenosis (mean Doppler flow gradient > 5 mmHg) and/or more than mild AV stenosis (peak Doppler flow gradient >20 mmHg) were excluded. Patients were divided into two groups based on initial intervention - primary Bi-V repair and hybrid/ other staging procedure. Outcomes were categorized as successful primary Bi-V repair, successful staged Bi-V repair and failure to achieve Bi-V repair (hybrid followed by SV palliation, transplant, death). Fisher exact test and Mann-Whitney U test was utilized to explore potential relationships. ROC curves were used to test diagnostic accuracy of parameters to predict successful primary Bi-V repair. Results Among 37 patients meeting the inclusion criteria, 23 (62%) patients underwent successful primary Bi-V repair, 8 (22%) underwent staged Bi-V repair, 6 (16%) failed to achieve Bi-V repair. Patients who underwent successful primary/ staged Bi-V repair had higher values for left ventricular diastolic volume index (LVEDVi 28 mL/m 2 vs. 17.4.00 mL/m 2 ; p 27 mL/m 2 and Q Ao is > 1.99 L/min/m 2 .
House et al. (Sat,) studied this question.