Faculty Collaboration Database

Doppler flow patterns in the right ventricle-to-pulmonary artery shunt and neo-aorta in infants with single right ventricle anomalies: impact on outcome after initial staged palliations. J Am Soc Echocardiogr 2013 May;26(5):521-9

Date

04/02/2013

Pubmed ID

23540728

Pubmed Central ID

PMC4208752

DOI

10.1016/j.echo.2013.02.012

Scopus ID

2-s2.0-84876725089 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

BACKGROUND: A Pediatric Heart Network trial compared outcomes in infants with single right ventricle anomalies undergoing Norwood procedures randomized to modified Blalock-Taussig shunt (MBTS) or right ventricle-to-pulmonary artery shunt (RVPAS). Doppler patterns in the neo-aorta and RVPAS may characterize physiologic changes after staged palliations that affect outcomes and right ventricular (RV) function.

METHODS: Neo-aortic cardiac index (CI), retrograde fraction (RF) in the descending aorta and RVPAS conduit, RVPAS/neo-aortic systolic ejection time ratio, and systolic/diastolic (S/D) ratio were measured early after Norwood, before stage II palliation, and at 14 months. These parameters were compared with transplantation-free survival, length of hospital stay, and RV functional indices.

RESULTS: In 529 subjects (mean follow-up period, 3.0 ± 2.1 years), neo-aortic CI and descending aortic RF were significantly higher in the MBTS cohort after Norwood. The RVPAS RF averaged <25% at both interstage intervals. Higher pre-stage II descending aortic RF was correlated with lower RV ejection fraction (R = -0.24; P = .032) at 14 months for the MBTS cohort. Higher post-Norwood CI (5.6 vs 4.4 L/min/m(2), P = .04) and lower S/D ratio (1.40 vs 1.68, P = .01) were correlated with better interstage transplantation-free survival for the RVPAS cohort. No other Doppler flow patterns were correlated with outcomes.

CONCLUSIONS: After the Norwood procedure, infants tolerated significant descending aortic RF (MBTS) and conduit RF (RVPAS), with little correlation with clinical outcomes or RV function. Neo-aortic CI, ejection time, and S/D ratios also had limited correlations with outcomes or RV function, but higher post-Norwood neo-aortic CI and lower S/D ratio were correlated with better interstage survival in those with RVPAS.

Author List

Frommelt PC, Gerstenberger E, Baffa J, Border WL, Bradley TJ, Colan S, Gorentz J, Heydarian H, John JB, Lai WW, Levine J, Lu JC, McCandless RT, Miller S, Nutting A, Ohye RG, Pearson GD, Wong PC, Cohen MS, Pediatric Heart Network Investigators

Author

Peter C. Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

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

Aorta, Thoracic
Blalock-Taussig Procedure
Echocardiography, Doppler
Heart Ventricles
Humans
Hypoplastic Left Heart Syndrome
Infant
Infant, Newborn
Length of Stay
Norwood Procedures
Palliative Care
Pulmonary Artery
Treatment Outcome
Ultrasonography, Prenatal