Clinical Course and Outcome of Children with Single Ventricle Physiology at King Chulalongkorn Memorial Hospital
Apichai Khongphatthanayothin MD*, Kanokorn Rattanawilaisak MD*, Vichai Benjacholamas MD**, Chule Numchaisiri MD**, Boonchu Sirichonkolthong MD*, Pairoj Chotivitayatarakorn MD*, Pornthep Lertsapcharoen MD*
Affiliation : * Department of Pediatrics, Faculty of Medicine, Chulalongkorn University ** Department of Surgery, Faculty of Medicine, Chulalongkorn University
Background : Children with single ventricle physiology comprise 10% of all children with congenital heart
disease (CHD) and one-third of children with cyanotic CHD seen at King Chulalongkorn Memorial Hospital.
The prognosis of these children is generally thought to be poor, but no study of the outcome has previously
been done in this hospital and in Thailand.
Objectives : To study the clinical course and outcome of children with single ventricle physiology at King
Chulalongkorn Memorial Hospital during the current era.
Materials and Methods : One hundred and seventeen patients with single ventricle physiology were initially
seen at this hospital during the year 1999-2001. Retrospective chart reviews were carried out in 90 children
with available medical records. The status of the patients was determined in 2003 at clinic visits, by phone
calls and mail.
Results : The main diagnoses were tricuspid atresia (TA, n = 10), pulmonary atresia with intact ventricular
septum (PA/IVS, n = 16), single ventricle associated with cardiac malposition or heterotaxy syndrome (malpo-
sition, n = 35), hypoplastic left heart syndrome (HLHS, n = 11) and other complex single ventricle (others, n
= 18). Most children did not have other major anomalies. Survival of patients with TA and PA/IVS was
approximately 92 and 87% at 1 and 4 years, respectively. For patients in the other three groups, 1 and 4 year
survival was 69 and 42%, respectively. Patients with HLHS had the worse survival, partly because of decisions
not to pursue further treatments by the parents. Among HLHS patients who underwent Norwood procedure,
the 1 and 4 year survival were 83% and 42%, respectively. Approximately 40 and 90% of all patients under-
went heart surgery at 1 and 4 years follow-up, respectively.
Conclusion : Despite limited resource, the short-term outcome of Thai children with single morphologic left
ventricle (TA and PA/IVS) is reasonably good. Timely evaluation and treatment of these children toward
Fontan procedure should be ensured. After proper discussion with the parents, palliative care is still accept-
able for patients with single morphologic right ventricle or other complex single ventricle due to poor
survival in the current era. As access to health care improves, re-evaluation of these outcomes is necessary to
find the best strategy for the management of these patients.
Keywords : Congenital heart disease, Outcome, Single ventricle
