A de-identified composite learning case.
A neonate has obstructed systemic blood flow related to severe coarctation of the aorta and arch hypoplasia.
The baby also has small left-sided structures, including a smaller mitral valve, bicuspid aortic valve, and borderline left ventricular size.
Before surgery, the ductus supports systemic blood flow beyond the obstruction.
After multidisciplinary review, the team determines that the left heart has reasonable potential to support a biventricular circulation.
The baby goes to the operating room for arch repair and relief of obstruction.
The central question is not only whether the obstruction can be repaired.
The deeper physiology question is:
Can the left heart support systemic flow once the ductal pathway is no longer the safety valve?
After relief of obstructed systemic flow, can the left heart provide enough effective forward output to support the body?
This is the key edge-case question.
The anatomy may be repaired.
The pathway may be open.
The echo may show ventricular function.
But the physiology still has to declare itself.