Key result
Patients undergoing biventricular repair had significantly larger mitral valve Z-scores after bilateral pulmonary artery banding compared to those undergoing univentricular repair (0.05 vs -1.86, P<0.01).
Why the study?
Factors associated with deciding between biventricular repair or univentricular repair in patients with left heart obstructive diseases after bilateral pulmonary artery banding were not clearly defined.
What factors are associated with the decision to perform biventricular repair versus univentricular repair in patients with left heart obstructive diseases after bilateral pulmonary artery banding?
Cohort (n=30)
What factors are associated with the decision to perform biventricular repair versus univentricular repair in patients with left heart obstructive diseases after bilateral pulmonary artery banding?
A large mitral valve from birth and growth of the aortic valve after bilateral pulmonary artery banding are crucial factors for successful biventricular repair in patients with borderline left ventricle.
Answers are grounded in this paper and cite their sources.
May inform biventricular repair decisions in borderline left heart obstruction; leaves open prospective validation of mitral valve thresholds.
Objective The study objective was to examine factors associated with the decision to perform biventricular repair or univentricular repair in patients with left heart obstructive diseases after bilateral pulmonary artery banding. Methods In this retrospective study, we used data from an institutional database. In total, 12 patients who underwent univentricular repair (group U) and 18 patients who underwent biventricular repair (group B) were included in the analysis. Left heart obstructive diseases included critical aortic stenosis, coarctation complex, interruption of aortic arch, and hypoplastic left heart complex. The Z-scores of the mitral, aortic, tricuspid, and pulmonary valve diameters, along with other parameters, were compared before and after bilateral pulmonary artery banding. Three months after the initial bilateral pulmonary artery banding, a cardiac catheter examination was performed in all patients to determine whether univentricular repair or biventricular repair should be performed. Results Mitral valve size in group B was significantly larger than in group U both before (−0.27 ± 1.04 vs −2.25 ± 1.83, P < .01) and after bilateral pulmonary artery banding (0.05 ± 1.58 vs −1.86 ± 1.91, P < .01). In group U, mitral and aortic valve sizes showed no significant increase after bilateral pulmonary artery banding. In group B, mitral valve size showed no significant increase after bilateral pulmonary artery banding (−0.27 ± 1.04 vs 0.06 ± 1.58, P = .26), whereas aortic valve size demonstrated a significant increase (−4.33 ± 2.60 vs −3.13 ± 2.64, P = .02). Conclusions In cases of a "borderline" left ventricle, a large mitral valve from birth and growth of the aortic valve are crucial for successful biventricular repair. Three months after bilateral pulmonary artery banding is considered the appropriate time to decide the management course to be pursued.
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Asada et al. (2025) conducted a cohort in Left heart obstructive diseases after bilateral pulmonary artery banding (n=30). Biventricular repair vs. Univentricular repair was evaluated on Mitral valve size Z-score after bilateral pulmonary artery banding (p=<.01). Patients undergoing biventricular repair had significantly larger mitral valve Z-scores after bilateral pulmonary artery banding compared to those undergoing univentricular repair (0.05 vs -1.86, P<0.01).
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