Initial shunt type at the Norwood operation impacts myocardial function in hypoplastic left heart syndrome.

Abstract

OBJECTIVES:

We investigated the impact of initial shunt type, a Blalock-Taussig (BT) shunt versus a right ventricle to pulmonary artery conduit (RV-PA) on myocardial function at different stages of surgical palliation in patients with hypoplastic left heart syndrome (HLHS).

METHODS:

A population-based cohort of 63 Finnish children with HLHS (BT n  = 23, RV-PA n  = 40) born between 2003 and 2010 were studied retrospectively by echocardiography prior to Stages 1, 2 and 3 palliation and 0.5-3 years after Stage 3. For comparison of systolic myocardial function, we evaluated the RV fractional area change (FAC), strain, strain rate and mechanical synchrony from the apical 4-chamber view by velocity vector imaging.

RESULTS:

There were no intergroup differences in demographics during the study period. At baseline, no intergroup differences were detected in RV systolic myocardial function. Before Stage 2, RV FAC was higher ( P  = 0.03) in the RV-PA conduit group. At Stage 3, an increase in all systolic myocardial functional parameters was observed in the BT shunt group. After Stage 3, the BT shunt group had better RV systolic function. In multiple regression analysis, the shunt type and the stage of palliation had an impact on myocardial function.

CONCLUSIONS:

Although patients with HLHS initially palliated with a BT shunt demonstrate lower RV FAC after Stage I, RV FAC improves after Stage 2 with better systolic performance after Stage 3 compared with those initially palliated with an RV-PA conduit.

• Authors: Hanna K Ruotsalainen, Jaana Pihkala, Jukka Salminen, Lisa K Hornberger, Heikki Sairanen, Tiina Ojala
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 52 Issue 2 Pg. 234-240 (Aug 01 2017) ISSN: 1873-734X [Electronic] Germany
• PMID: 28444210 (Publication Type: Journal Article)
• Copyright: © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Topics

• Blalock-Taussig Procedure (statistics & numerical data)
• Cardiac Catheterization
• Child, Preschool
• Echocardiography
• Female
• Heart (diagnostic imaging, physiopathology)
• Humans
• Hypoplastic Left Heart Syndrome (diagnostic imaging, epidemiology, surgery)
• Infant
• Infant, Newborn
• Male
• Norwood Procedures (instrumentation, statistics & numerical data)
• Palliative Care
• Retrospective Studies