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Effect of shunt type on echocardiographic indices after initial palliations for hypoplastic left heart syndrome: Blalock-Taussig shunt versus right ventricle-pulmonary artery conduit. J Am Soc Echocardiogr 2007 Dec;20(12):1364-73

Date

07/03/2007

Pubmed ID

17604955

DOI

10.1016/j.echo.2007.04.009

Scopus ID

2-s2.0-36549019972   41 Citations

Abstract

OBJECTIVES: The study objective was to compare echocardiographic indices in infants with hypoplastic left heart syndrome (HLHS) randomized to different surgical pathways.

BACKGROUND: Initial surgical palliation for HLHS has evolved to two strategies that vary by source of pulmonary blood flow: a modified Blalock-Taussig (BT) shunt or a right ventricle to pulmonary artery (RV-PA) conduit.

METHODS: Seventeen patients were randomized to either a BT shunt or RV-PA as their first-stage palliation, and 15 survived through bidirectional Glenn (BDG) (seven BT shunts/eight RV-PAs). Echocardiography was performed pre-stage 1 palliation (S1P), early post-S1P, pre-BDG, and post-BDG. Echocardiographic measurements included indices of right ventricle function and shape, right ventricle myocardial performance index, neoaortic Doppler flow patterns and cardiac output, Doppler inflow and tissue imaging, and conduit/neoaortic regurgitant fraction.

RESULTS: There were no significant differences in right ventricle size, shape, or estimates of systolic and diastolic function between groups. Patterns of changes in neoaortic Doppler flow in the RV-PA conduit group showed a decrease in all indices of systemic flow early after initial palliation, but these measures consistently increase later post-S1P and post-BDG. In contrast, the BT shunt group increases these same indices post-S1P and pre-BDG with a decrease after shunt removal.

CONCLUSIONS: Right ventricle size and function do not appear significantly affected by surgical type of initial palliation for HLHS, and this correlates with early outcome. Echocardiographic Doppler findings correlate well with the expected physiologies of the different shunts as these infants progress through initial palliative strategies.

Author List

Frommelt PC, Sheridan DC, Mussatto KA, Hoffman GM, Ghanayem NS, Frommelt MA, Tweddell JS

Authors

Michele Ann Frommelt MD Professor in the Pediatrics department at Medical College of Wisconsin
Peter C. Frommelt MD Professor in the Pediatrics department at Medical College of Wisconsin
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of Wisconsin
Kathleen Mussatto in the CTSI department at Medical College of Wisconsin - CTSI




MESH terms used to index this publication - Major topics in bold

Anastomosis, Surgical
Echocardiography
Female
Heart Ventricles
Humans
Hypoplastic Left Heart Syndrome
Infant, Newborn
Male
Palliative Care
Prognosis
Pulmonary Artery
Treatment Outcome
jenkins-FCD Prod-398 336d56a365602aa89dcc112f077233607d6a5abc