Rao P Syamasundar
Children's Heart Institute, Children's Memorial Hermann Hospital, McGovern Medical School, University of Texas-Houston, Houston, TX 77030, USA.
Children (Basel). 2022 Aug 24;9(9):1274. doi: 10.3390/children9091274.
Double-inlet left ventricle (DILV) is most frequent among univentricular atrioventricular connections. In DILV, there is a single functioning ventricle, most commonly with left ventricular structure. This chamber receives both atrioventricular valves and is connected to an outlet chamber with morphologic features of the right ventricle. The great vessels are often transposed, and pulmonary stenosis is seen in two-thirds of patients. The anatomy and pathophysiology can be defined by echo-Doppler studies with a rare need for other imaging studies. The management is mostly related to the nature of associated heart defects and the degree of pathophysiological abnormality. When the infants present initially, treatment to address the hemodynamic issues is undertaken. Subsequently, these babies need staged total cavo-pulmonary connection, i.e., the Fontan procedure which is undertaken in three stages; these stages are described in this review. The existence of inter-stage mortality and post-Fontan complications is recognized and was reviewed. The paper concludes that DILV can be successfully diagnosed with echo-Doppler studies and this heart anomaly can be effectively treated with the currently prevailing medical, catheter interventional, and surgical treatment practices.
双入口左心室(DILV)在单心室房室连接中最为常见。在DILV中,存在一个功能正常的心室,最常见的是具有左心室结构。该腔室接收两个房室瓣,并与具有右心室形态特征的流出腔相连。大血管常发生转位,三分之二的患者可见肺动脉狭窄。通过超声多普勒研究可以明确其解剖结构和病理生理情况,很少需要其他影像学检查。治疗主要与相关心脏缺陷的性质和病理生理异常程度有关。婴儿初诊时,需进行治疗以解决血流动力学问题。随后,这些婴儿需要分期进行全腔静脉-肺动脉连接术,即分三个阶段进行的Fontan手术;本综述将对这些阶段进行描述。认识到阶段间死亡率和Fontan术后并发症的存在并进行了综述。本文得出结论,DILV可以通过超声多普勒研究成功诊断,并且这种心脏异常可以通过目前流行的药物、导管介入和手术治疗方法得到有效治疗。