Document Detail


Does initial shunt type for the Norwood procedure affect echocardiographic measures of cardiac size and function during infancy?: the Single Vventricle Reconstruction trial.
MedLine Citation:
PMID:  22523314     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Pediatric Heart Network trial comparing outcomes in 549 infants with single right ventricle undergoing a Norwood procedure randomized to modified Blalock-Taussig shunt or right ventricle-pulmonary artery shunt (RVPAS) found better 1-year transplant-free survival in those who received RVPAS. We sought to compare the impact of shunt type on echocardiographic indices of cardiac size and function up to 14 months of age.
METHODS AND RESULTS: A core laboratory measured indices of cardiac size and function from protocol exams: early after Norwood procedure (age 22.5 ± 13.4 days), before stage II procedure (age 4.8 ± 1.8 months), and at 14 months (age 14.3 ± 1.2 months). Mean right ventricular ejection fraction was <50% at all intervals for both groups and was higher in the RVPAS group after Norwood procedure (49 ± 7% versus 44 ± 8%; P<0.001) but was similar by 14 months. Tricuspid and neoaortic regurgitation, diastolic function, and pulmonary artery and arch dimensions were similar in the 2 groups at all intervals. Neoaortic annulus area (4.2 ± 1.2 versus 4.9 ± 1.2 cm(2)/m(2)), systolic ejection times (214.0 ± 29.4 versus 231.3 ± 28.6 ms), neoaortic flow (6.2 ± 2.4 versus 9.4 ± 3.4 L/min per square meter), and peak arch velocity (1.9 ± 0.7 versus 2.2 ± 0.7 m/s) were lower at both interstage examinations in the RVPAS compared with the modified Blalock-Taussig shunt group (P<0.001 for all), but all were similar at 14 months.
CONCLUSIONS: Indices of cardiac size and function after the Norwood procedure are similar for modified Blalock-Taussig shunt and RVPAS by 14 months of age. Interstage differences between shunt types can likely be explained by the physiology created when the shunts are in place rather than by intrinsic differences in cardiac function.
CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00115934.
Authors:
Peter C Frommelt; Lin T Guey; L LuAnn Minich; Majeed Bhat; Tim J Bradley; Steve D Colan; Greg Ensing; Jessica Gorentz; Haleh Heydarian; J Blaine John; Wyman W Lai; Jami C Levine; William T Mahle; Stephen G Miller; Richard G Ohye; Gail D Pearson; Girish S Shirali; Pierre C Wong; Meryl S Cohen;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2012-04-21
Journal Detail:
Title:  Circulation     Volume:  125     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-30     Completed Date:  2012-08-07     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2630-8     Citation Subset:  AIM; IM    
Affiliation:
Medical College of Wisconsin, Milwaukee, USA. pfrommelt@chw.org
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00115934
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical / methods
Blalock-Taussig Procedure / methods
Diastole / physiology
Echocardiography*
Heart Ventricles / physiopathology,  surgery*
Humans
Hypoplastic Left Heart Syndrome / physiopathology,  surgery*
Infant
Infant, Newborn
Myocardium / pathology*
Norwood Procedures / methods*
Organ Size
Pulmonary Artery / surgery*
Stroke Volume / physiology
Systole / physiology
Treatment Outcome
Grant Support
ID/Acronym/Agency:
U01 HL068269/HL/NHLBI NIH HHS; U01 HL068270/HL/NHLBI NIH HHS; U01 HL068270/HL/NHLBI NIH HHS; U01 HL068279/HL/NHLBI NIH HHS; U01 HL068281/HL/NHLBI NIH HHS; U01 HL068285/HL/NHLBI NIH HHS; U01 HL068288/HL/NHLBI NIH HHS; U01 HL068290/HL/NHLBI NIH HHS; U01 HL068292/HL/NHLBI NIH HHS; U01 HL085057/HL/NHLBI NIH HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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