Document Detail

Ventriculoarterial coupling in palliated hypoplastic left heart syndrome: Noninvasive assessment of the effects of surgical arch reconstruction and shunt type.
MedLine Citation:
PMID:  24629219     Owner:  NLM     Status:  Publisher    
OBJECTIVE: To assess the coupling efficiency in hypoplastic left heart syndrome, considering the effect of surgical arch reconstruction and the shunt type received during the Norwood procedure.
METHODS: Ventriculoarterial coupling was assessed before Fontan completion in 32 patients with hypoplastic left heart syndrome (19 modified Blalock-Taussig and 13 Sano shunts at stage 1). Cardiovascular magnetic resonance data were analyzed, deriving functional parameters and 3-dimensional volumes. Dimensional indexes were computed from 3-dimensional data sets as the area ratio of the isthmus to the descending aorta (Risthmus) and the isthmus to surgically enlarged transverse arch (Rarch). Wave intensity was calculated from cardiac magnetic resonance, using the peaks of the forward compression and expansion waves in early and late systole as surrogate indicators of ventriculoarterial coupling.
RESULTS: Aortic distensibility (3.6 ± 2.7 × 10(-3) 1/mm Hg) was not associated with the time elapsed from stage 1 palliation (P = .94), suggesting an early loss of elasticity that did not progress thereafter. Risthmus was 1.0 ± 0.4, and Rarch was 0.3 ± 0.1, indicating the dilated reconstructed arch was the main anatomic feature. The forward compression wave correlated significantly with Rarch (R(2) = 0.23, P = .006) but not with Risthmus (R(2) <0.01, P = .63). Patients with a reduced ejection fraction exhibited a larger ventricular mass (R(2) = 0.28, P = .003). The Sano shunt patients had a lower ejection fraction (51% ± 6% vs 57% ± 6%, P = .02); however, neither the forward compression nor expansion wave varied significantly between shunt type or the other functional parameters.
CONCLUSIONS: Ventriculoarterial coupling in operated hypoplastic left heart syndrome was affected by aortic arch size mismatch but not by the type of shunt placed at the Norwood operation.
Giovanni Biglino; Alessandro Giardini; Hopewell N Ntsinjana; Silvia Schievano; Tain-Yen Hsia; Andrew M Taylor;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-2-10
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  -     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-3-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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