Ventriculocoronary connections in hypoplastic left hearts: an autopsy microscopic study.

Serial microscopic sections of the left ventricular myocardium were examined in 12 autopsy specimens of hypoplastic left heart syndrome. Multiple ventriculocoronary arterial connections, thickwalled coronary arteries, prominent endocardial fibroelastosis, myofiber disarray and focal calcification/ scarring of the myocardium were noted in the cases with patent left ventricular inflow and obstructed outflow. The persistent embryonic microvascular pattern noted in these cases may be related to intrauterine outflow obstruction and could limit surgical attempts to produce a functional left ventricle in infants with hypoplastic left heart syndrome.