Autopsy and Case Reports
https://app.periodikos.com.br/journal/autopsy/article/doi/10.4322/acr.2014.025
Autopsy and Case Reports
Article / Autopsy Case Report

Classic form of hypoplastic left heart syndrome diagnosed post-natally: an autopsy report

Cristiane Rúbia Ferreira; Vera Demarchi Aiello; Ana Maria Andrello Gonçalves Pereira de Melo; Lucas Braga Mota; Ana Carolina Neves de Carvalho; Heli Samuel Pinto Souza; Diana Arrais de Souza Rangel

Downloads: 5
Views: 1430

Abstract

Hypoplastic left heart syndrome (HLHS) is a congenital heart disease, which, despite the current improved knowledge about its management and surgical treatment, is still associated with high mortality, especially in the early neonatal period and before the second stage of reconstruction surgery. The low rate of prenatal diagnosis and delayed diagnostic suspicion results in unsuccessful therapeutic intervention, even though the real impact of early diagnosis and intervention on mortality and quality of life of patients is still uncertain. Fortunately, this syndrome of challenging treatment is not that frequent. It involves a spectrum of obstructions to the blood flow within the left heart and is characterized by an inappropriate size of the left ventricle associated with a wide variety of valvular dysfunctions. Treatment ranges from heart transplantation to palliative surgical procedures. The authors describe a case of a newborn with HLHS, whose diagnosis was made after birth because of early respiratory failure. Despite the use of prostaglandin the newborn died. An autopsy was performed and the anatomical findings were described.
 

Keywords

Hypoplastic Left Heart Syndrome, Respiratory Insufficiency, Shock, Cardiogenic, Autopsy

References

Hunter LE, Simpson JM. Prenatal screening for structural congenital heart disease. Nat Rev Cardiol. 2014;11(6):323-34. http://dx.doi.org/ [https://doi.org/10.1038/nrcardio.2014.34]. PMid: [PMID:24663090]

Bardeleben K. Obliteration of the left ostium arteriosum in the heart of a half-year old infant. In: Virchow R, Reinhardt B, editors. Archiv für patologische anatomie und physiologie und für klinishe medicin. Berlin: G. Reimer; 1851. v. 3. p. 305-12.

Noonan JA, Nadas AS. The hypoplastic left heart syndrome; an analysis of 101 cases. Pediatr Clin North Am. 1958;5(4):1029-56. PMid: [PMID:13600906].

Gehrmann J, Krasemann T, Kehl HG, Vogt J. Hypoplastic left-heart syndrome: the first description of the pathophysiology in 1851; translation of a publication by Dr. Bardeleben from Giessen, Germany. Chest. 2001;120(4):1368-71. http://dx.doi.org/ [https://doi.org/10.1378/chest.120.4.1368]. PMid: [PMID:11591582]

Lev M. Pathologic anatomy and interrelationship of hypoplasia of the aortic tract complexes. Lab Invest. 1952;1(1):61-70. PMid: [PMID:14939725].

Lev M. Some newer concepts of the pathology of congenital heart disease. Med Clin North Am. 1966;50(1):3-14. PMid: [PMID:5324684].

Fantini FA, Gontijo Filho B, Martins Cet al. A operação de Norwood modificada para tratamento da síndrome de hipoplasia do coração esquerdo. Rev Bras Cir Cardiovasc. 2004;19(1):42-6. Portuguese. http://dx.doi.org/ [https://doi.org/10.1590/S0102-76382004000100009].

Hunter LE, Simpson JM. Prenatal screening for structural congenital heart disease. Nat Rev Cardiol. 2014;11(6):323-34. http://dx.doi.org/ [https://doi.org/10.1038/nrcardio.2014.34]. PMid: [PMID:24663090]

Tchervenkov CI, Jacobs JP, Weinberg PMet al. The nomenclature, definition and classification of hypoplastic left heart syndrome. Cardiol Young. 2006;16(4):339-68. http://dx.doi.org/ [https://doi.org/10.1017/S1047951106000291]. PMid: [PMID:16839428]

Aiello VD, Ho SY, Anderson RH, Thiene G. Morphologic features of the hypoplastic left heart syndrome—a reappraisal. Pediatr Pathol. 1990;10(6):931-43. http://dx.doi.org/ [https://doi.org/10.3109/15513819009064728]. PMid: [PMID:2082338]

Kearney DL. The pathological spectrum of left-ventricular hypoplasia. Semin Cardiothorac Vasc Anesth. 2013;17(2):105-16. http://dx.doi.org/ [https://doi.org/10.1177/1089253213488247]. PMid: [PMID:23657433]

Tweddell JS, Hoffman GM, Mussatto KAet al. Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation. 2002;106(12 Suppl 1):I82-9. PMid: [PMID:12354714].

Feinstein JA, Benson DW, Dubin AMet al. Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol. 2012;59(1 Suppl):S1-42. http://dx.doi.org/ [https://doi.org/10.1016/j.jacc.2011.09.022]. PMid: [PMID:22192720]

Graham EM, Bradley SM, Atz AM. Preoperative management of hypoplastic left heart syndrome. Expert Opin Pharmacother. 2005;6(5):687-93. http://dx.doi.org/ [https://doi.org/10.1517/14656566.6.5.687]. PMid: [PMID:15934895]

Sotiriadis A, Papatheodorou S, Eleftheriades M, Makrydimas G. Nuchal translucency and major congenital heart defects in fetuses with normal karyotype: a meta-analysis. Ultrasound Obstet Gynecol. 2013;42(4):383-9. PMid: [PMID:23606595].

Vlahos AP, Lock JE, McElhinney DB, van der Velde ME. Hypoplastic left heart syndrome with intact or highly restrictive atrial septum: outcome after neonatal transcatheter atrial septostomy. Circulation. 2004;109(19):2326-30. http://dx.doi.org/ [https://doi.org/10.1161/01.CIR.0000128690.35860.C5]. PMid: [PMID:15136496]

Morris SA, Ethen MK, Penny DJet al. Prenatal diagnosis, birth location, surgical center, and neonatal mortality in infants with hypoplastic left heart syndrome. Circulation. 2014;129(3):285-92. http://dx.doi.org/ [https://doi.org/10.1161/CIRCULATIONAHA.113.003711]. PMid: [PMID:24135071]

Tworetzky W, McElhinney DB, Reddy VM, Brook MM, Hanley FL, Silverman NH. Improved surgical outcome after fetal diagnosis of hypoplastic left heart syndrome. Circulation. 2001;103(9):1269-73. http://dx.doi.org/ [https://doi.org/10.1161/01.CIR.103.9.1269]. PMid: [PMID:11238272]

Mahle WT, Clancy RR, McGaurn SP, Goin JE, Clark BJ. Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics. 2001;107(6):1277-82. http://dx.doi.org/ [https://doi.org/10.1542/peds.107.6.1277]. PMid: [PMID:11389243]

Satomi G, Yasukochi S, Shimizu T, Takigiku K, Ishii T. Has fetal echocardiography improved the prognosis of congenital heart disease? Comparison of patients with hypoplastic left heart syndrome with and without prenatal diagnosis. Pediatr Int. 1999;41(6):728-32. http://dx.doi.org/ [https://doi.org/10.1046/j.1442-200x.1999.01154.x]. PMid: [PMID:10618902]

Murtuza B, Elliott MJ. Changing attitudes to the management of hypoplastic left heart syndrome: a European perspective. Cardiol Young. 2011;21(S2 Suppl 2):148-58. http://dx.doi.org/ [https://doi.org/10.1017/S1047951111001739]. PMid:22152542

Norwood WI, Lang P, Hansen DD. Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med. 1983;308(1):23-6. http://dx.doi.org/ [https://doi.org/10.1056/NEJM198301063080106]. PMid: [PMID:6847920]

Norwood WI, Lang P, Casteneda AR, Campbell DN. Experience with operations for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 1981;82(4):511-9. PMid: [PMID:6168869].

Silva JP, Fonseca L, Baumgratz JFet al. Síndrome da hipoplasia do coração esquerdo: a influência da estratégia cirúrgica nos resultados. Arq Bras Cardiol. 2007;88(3):354-60. Portuguese. http://dx.doi.org/ [https://doi.org/10.1590/S0066-782X2007000300016]. PMid:17533479.

Fonseca L, Silva JP, Franchi SM, Castro RM, Comparato DO, Baumgratz JF. Operação de Glenn bidirecional no tratamento estagiado da síndrome de hipoplasia do coração esquerdo: resultados imediatos e tardios. Rev Bras Cir Cardiovasc. 2005;20(1):1-7. Portuguese. http://dx.doi.org/ [https://doi.org/10.1590/S0102-76382005000100005].

Fantini FA, Gontijo B, Martins Cet al. Operação de Fontan: uma técnica em evolução. Rev Bras Cir Cardiovasc. 2009;24(4):463-9. Portuguese. http://dx.doi.org/ [https://doi.org/10.1590/S0102-76382009000500006]. PMid:20305918.

Sano S, Ishino K, Kawada Met al. Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2003;126(2):504-9, discussion 509-10. http://dx.doi.org/ [https://doi.org/10.1016/S0022-5223(02)73575-7]. PMid: [PMID:12928651]

Chauhan M, Mastropietro CW. Hypoplastic left heart syndrome in the emergency department: an update. J Emerg Med. 2014;46(2):e51-4. http://dx.doi.org/ [https://doi.org/10.1016/j.jemermed.2013.08.061]. PMid: [PMID:24188609]

Bacha EA, Daves S, Hardin Jet al. Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage I strategy. J Thorac Cardiovasc Surg. 2006;131(1):163-171. http://dx.doi.org/ [https://doi.org/10.1016/j.jtcvs.2005.07.053]. PMid: [PMID:16399308]

Caldarone CA, Benson L, Holtby H, Li J, Redington AN, Van Arsdell GS. Initial experience with hybrid palliation for neonates with single-ventricle physiology. Ann Thorac Surg. 2007;84(4):1294-300. http://dx.doi.org/ [https://doi.org/10.1016/j.athoracsur.2007.04.127]. PMid: [PMID:17888986]

Galantowicz M, Cheatham JP, Phillips Aet al. Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg. 2008;85(6):2063-70, discussion 2070-1. http://dx.doi.org/ [https://doi.org/10.1016/j.athoracsur.2008.02.009]. PMid: [PMID:18498821]


 


Publication date:
01/13/2016

569696b464cc8b5cda711bfe autopsy Articles

Autops Case Rep

Share this page
Page Sections