Prognostic value of left ventricular size measured by echocardiography in infants with total anomalous pulmonary venous drainage

Left ventricular size may be a determinant of survival in infants with total anomalous pulmonary venous drainage. Right and left ventricular size were measured by M-mode and 2-dimensional (2-D) echocardiography in 13 patients aged 1 day to 4 months (mean weight 4.3 ± 0.42 kg [standard error of the estimate]) who underwent surgery before age 4 months because of severe cyanosis or cardiac failure. Seven patients had venous drainage to a vertical vein, 4 had drainage to the right atrium, and 2 had drainage to the inferior vena cava. Patients were divided into 2 groups: survivors (Group A, n = 8) and nonsurvivors (Group B, n = 5). Death was not statistically related to pulmonary artery pressure, pulmonary venous obstruction, age, or weight at the time of surgery. Right and left ventricular sizes at end-diastole measured from M-mode traces and 2-D echocardiographic 4-chamber views were compared with those from 15 weight-matched control infants. On M-mode and 2-D echocardiography, nonsurvivors had significantly larger right ventricles and smaller left ventricular dimensions than did either control subjects or surviving patients with total anomalous pulmonary venous drainage. The ratio of right to left ventricular size on M-mode and 2-D echocardiography also differed among the 3 infant groups (p < 0.001). The ratio of right to left ventricular size differentiated nonsurvivors from survivors and control subjects. Postmortem examinations available in 4 of the 5 nonsurvivors demonstrated that the ratio of right to left ventricular size in the specimens closely agreed with the 2-D echocardiographic ratios. Our study agrees with the impression of other investigators that left ventricular size may be a determinant of survival after repair of total anomalous pulmonary venous drainage.