Faculty Collaboration Database

Impact of initial norwood shunt type on right ventricular deformation: the single ventricle reconstruction trial. J Am Soc Echocardiogr 2015 May;28(5):517-21

Date

02/19/2015

Pubmed ID

25690998

Pubmed Central ID

PMC4426007

DOI

10.1016/j.echo.2015.01.018

Scopus ID

2-s2.0-84929506482 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

BACKGROUND: The Single Ventricle Reconstruction trial demonstrated a transplantation-free survival advantage at 12-month follow-up for patients with right ventricle-pulmonary artery shunts (RVPAS) with the Norwood procedure compared with modified Blalock-Taussig shunts but similar survival and decreased global right ventricular (RV) function on longer term follow-up. The impact of the required ventriculotomy for the RVPAS remains unknown. The aim of this study was to compare echocardiography-derived RV deformation indices after stage 2 procedures in survivors with single RV anomalies enrolled in the Single Ventricle Reconstruction trial.

METHODS: Global and regional RV systolic longitudinal and circumferential strain and strain rate, ejection fraction, and short-axis percentage fractional area change were all derived by speckle-tracking echocardiography from protocol echocardiograms obtained at 14.3 ± 1.2 months. Student t tests or Wilcoxon rank sum tests were used to compare groups.

RESULTS: The cohort included 275 subjects (129 in the modified Blalock-Taussig shunt group and 146 in the RVPAS group). Longitudinal deformation could be quantified in 214 subjects (78%) and circumferential measures in 182 subjects (66%). RV ejection fraction and percentage fractional area change did not differ between groups. There were no significant differences between groups for global or regional longitudinal deformation. Circumferential indices showed abnormalities in deformation in the RVPAS group, with decreased global circumferential strain (P = .05), strain rate (P = .09), and anterior regional strain rate (P = .07) that approached statistical significance.

CONCLUSIONS: RV myocardial deformation at 14 months, after stage 2 procedures, was not significantly altered by the type of initial shunt placed. However, abnormal trends were appreciated in circumferential deformation for the RVPAS group in the area of ventriculotomy that may represent early myocardial dysfunction. These data provide a basis for longer term RV deformation assessment in survivors after Norwood procedures.

Author List

Hill GD, Frommelt PC, Stelter J, Campbell MJ, Cohen MS, Kharouf R, Lai WW, Levine JC, Lu JC, Menon SC, Slesnick TC, Wong PC, Saudek DE

Authors

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

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

Blalock-Taussig Procedure
Echocardiography
Female
Follow-Up Studies
Heart Ventricles
Humans
Hypoplastic Left Heart Syndrome
Infant
Male
Norwood Procedures
Retrospective Studies
Stroke Volume
Treatment Outcome
Ventricular Function, Right