Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome

Heiner Latus, Mohamed S. Nassar, James Wong, Pauline Hachmann, Hannah Bellsham-Revell, Tarique Hussain, Christian Apitz, Caner Salih, Conal Austin, David Anderson, Can Yerebakan, Hakan Akintuerk, Juergen Bauer, Reza Razavi, Dietmar Schranz, Gerald Greil

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective Norwood and hybrid procedure are two options available for initial palliation of patients with hypoplastic left heart syndrome (HLHS). Our study aimed to assess potential differences in right ventricular (RV) function and pulmonary artery dimensions using cardiac magnetic resonance (CMR) in survivors with HLHS. Methods 42 Norwood (mean age 2.4±0.8) and 44 hybrid (mean age 2.0±1.0 years) patients were evaluated by CMR after stage II palliation prior to planned Fontan completion. Initial stage I Norwood procedure was performed using a modified Blalock-Taussig shunt, while the hybrid procedure consisted of bilateral pulmonary artery banding and arterial duct stenting. Need for reinterventions and subsequent outcomes were also assessed. Results Norwood patients had larger RV end-diastolic dimensions (91±23 vs 80±31 mL/m 2, p=0.004) and lower heart rate (90±15 vs 102±13, p<0.001) than hybrid patients. Both Norwood and hybrid patients showed preserved global RV pump function (59±9 vs 59%±10%, p=0.91), while RV strain, strain rate and intraventricular synchrony were superior in the Norwood group. Pulmonary artery size was reduced (lower lobe index 135±74 vs 161±62 mm2/m2, p=0.02), and reintervention rate was significantly higher in the hybrid group whereas subsequent outcome did not differ significantly (p=0.24). Conclusions Norwood and hybrid strategy were associated with equivalent and preserved global RV pump function while development of the pulmonary arteries and reintervention rate were superior using the Norwood approach. Impaired RV myocardial deformation as a potential marker of early RV dysfunction in the hybrid group may have a negative long-term impact in this population.

Original languageEnglish (US)
Pages (from-to)244-252
Number of pages9
JournalHeart
Volume104
Issue number3
DOIs
StatePublished - Feb 1 2018

Fingerprint

Hypoplastic Left Heart Syndrome
Ventricular Function
Blood Vessels
Right Ventricular Function
Pulmonary Artery
Norwood Procedures
Magnetic Resonance Spectroscopy
Blalock-Taussig Procedure
Right Ventricular Dysfunction
Survivors
Heart Rate
Population

Keywords

  • cardiac magnetic resonance (CMR) imaging
  • Complex congenital heart disease
  • Congenital heart disease surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome. / Latus, Heiner; Nassar, Mohamed S.; Wong, James; Hachmann, Pauline; Bellsham-Revell, Hannah; Hussain, Tarique; Apitz, Christian; Salih, Caner; Austin, Conal; Anderson, David; Yerebakan, Can; Akintuerk, Hakan; Bauer, Juergen; Razavi, Reza; Schranz, Dietmar; Greil, Gerald.

In: Heart, Vol. 104, No. 3, 01.02.2018, p. 244-252.

Research output: Contribution to journalArticle

Latus, H, Nassar, MS, Wong, J, Hachmann, P, Bellsham-Revell, H, Hussain, T, Apitz, C, Salih, C, Austin, C, Anderson, D, Yerebakan, C, Akintuerk, H, Bauer, J, Razavi, R, Schranz, D & Greil, G 2018, 'Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome', Heart, vol. 104, no. 3, pp. 244-252. https://doi.org/10.1136/heartjnl-2017-311532
Latus, Heiner ; Nassar, Mohamed S. ; Wong, James ; Hachmann, Pauline ; Bellsham-Revell, Hannah ; Hussain, Tarique ; Apitz, Christian ; Salih, Caner ; Austin, Conal ; Anderson, David ; Yerebakan, Can ; Akintuerk, Hakan ; Bauer, Juergen ; Razavi, Reza ; Schranz, Dietmar ; Greil, Gerald. / Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome. In: Heart. 2018 ; Vol. 104, No. 3. pp. 244-252.
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abstract = "Objective Norwood and hybrid procedure are two options available for initial palliation of patients with hypoplastic left heart syndrome (HLHS). Our study aimed to assess potential differences in right ventricular (RV) function and pulmonary artery dimensions using cardiac magnetic resonance (CMR) in survivors with HLHS. Methods 42 Norwood (mean age 2.4±0.8) and 44 hybrid (mean age 2.0±1.0 years) patients were evaluated by CMR after stage II palliation prior to planned Fontan completion. Initial stage I Norwood procedure was performed using a modified Blalock-Taussig shunt, while the hybrid procedure consisted of bilateral pulmonary artery banding and arterial duct stenting. Need for reinterventions and subsequent outcomes were also assessed. Results Norwood patients had larger RV end-diastolic dimensions (91±23 vs 80±31 mL/m 2, p=0.004) and lower heart rate (90±15 vs 102±13, p<0.001) than hybrid patients. Both Norwood and hybrid patients showed preserved global RV pump function (59±9 vs 59{\%}±10{\%}, p=0.91), while RV strain, strain rate and intraventricular synchrony were superior in the Norwood group. Pulmonary artery size was reduced (lower lobe index 135±74 vs 161±62 mm2/m2, p=0.02), and reintervention rate was significantly higher in the hybrid group whereas subsequent outcome did not differ significantly (p=0.24). Conclusions Norwood and hybrid strategy were associated with equivalent and preserved global RV pump function while development of the pulmonary arteries and reintervention rate were superior using the Norwood approach. Impaired RV myocardial deformation as a potential marker of early RV dysfunction in the hybrid group may have a negative long-term impact in this population.",
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T1 - Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome

AU - Latus, Heiner

AU - Nassar, Mohamed S.

AU - Wong, James

AU - Hachmann, Pauline

AU - Bellsham-Revell, Hannah

AU - Hussain, Tarique

AU - Apitz, Christian

AU - Salih, Caner

AU - Austin, Conal

AU - Anderson, David

AU - Yerebakan, Can

AU - Akintuerk, Hakan

AU - Bauer, Juergen

AU - Razavi, Reza

AU - Schranz, Dietmar

AU - Greil, Gerald

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objective Norwood and hybrid procedure are two options available for initial palliation of patients with hypoplastic left heart syndrome (HLHS). Our study aimed to assess potential differences in right ventricular (RV) function and pulmonary artery dimensions using cardiac magnetic resonance (CMR) in survivors with HLHS. Methods 42 Norwood (mean age 2.4±0.8) and 44 hybrid (mean age 2.0±1.0 years) patients were evaluated by CMR after stage II palliation prior to planned Fontan completion. Initial stage I Norwood procedure was performed using a modified Blalock-Taussig shunt, while the hybrid procedure consisted of bilateral pulmonary artery banding and arterial duct stenting. Need for reinterventions and subsequent outcomes were also assessed. Results Norwood patients had larger RV end-diastolic dimensions (91±23 vs 80±31 mL/m 2, p=0.004) and lower heart rate (90±15 vs 102±13, p<0.001) than hybrid patients. Both Norwood and hybrid patients showed preserved global RV pump function (59±9 vs 59%±10%, p=0.91), while RV strain, strain rate and intraventricular synchrony were superior in the Norwood group. Pulmonary artery size was reduced (lower lobe index 135±74 vs 161±62 mm2/m2, p=0.02), and reintervention rate was significantly higher in the hybrid group whereas subsequent outcome did not differ significantly (p=0.24). Conclusions Norwood and hybrid strategy were associated with equivalent and preserved global RV pump function while development of the pulmonary arteries and reintervention rate were superior using the Norwood approach. Impaired RV myocardial deformation as a potential marker of early RV dysfunction in the hybrid group may have a negative long-term impact in this population.

AB - Objective Norwood and hybrid procedure are two options available for initial palliation of patients with hypoplastic left heart syndrome (HLHS). Our study aimed to assess potential differences in right ventricular (RV) function and pulmonary artery dimensions using cardiac magnetic resonance (CMR) in survivors with HLHS. Methods 42 Norwood (mean age 2.4±0.8) and 44 hybrid (mean age 2.0±1.0 years) patients were evaluated by CMR after stage II palliation prior to planned Fontan completion. Initial stage I Norwood procedure was performed using a modified Blalock-Taussig shunt, while the hybrid procedure consisted of bilateral pulmonary artery banding and arterial duct stenting. Need for reinterventions and subsequent outcomes were also assessed. Results Norwood patients had larger RV end-diastolic dimensions (91±23 vs 80±31 mL/m 2, p=0.004) and lower heart rate (90±15 vs 102±13, p<0.001) than hybrid patients. Both Norwood and hybrid patients showed preserved global RV pump function (59±9 vs 59%±10%, p=0.91), while RV strain, strain rate and intraventricular synchrony were superior in the Norwood group. Pulmonary artery size was reduced (lower lobe index 135±74 vs 161±62 mm2/m2, p=0.02), and reintervention rate was significantly higher in the hybrid group whereas subsequent outcome did not differ significantly (p=0.24). Conclusions Norwood and hybrid strategy were associated with equivalent and preserved global RV pump function while development of the pulmonary arteries and reintervention rate were superior using the Norwood approach. Impaired RV myocardial deformation as a potential marker of early RV dysfunction in the hybrid group may have a negative long-term impact in this population.

KW - cardiac magnetic resonance (CMR) imaging

KW - Complex congenital heart disease

KW - Congenital heart disease surgery

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