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

被引：6

作者：

Frommelt, Peter C. ^{[1
]}

Gerstenberger, Eric ^{[2
]}

Baffa, Jeanne ^{[3
]}

Border, William L. ^{[4
]}

Bradley, Tim J. ^{[5
]}

Colan, Steven ^{[6
]}

Gorentz, Jessica ^{[1
]}

Heydarian, Haleh ^{[7
]}

John, J. Blaine ^{[8
]}

Lai, Wyman W. ^{[9
]}

Levine, Jami ^{[6
]}

Lu, Jimmy C. ^{[10
]}

McCandless, Rachel T. ^{[11
]}

Miller, Stephen ^{[12
]}

Nutting, Arni ^{[13
]}

Ohye, Richard G. ^{[10
]}

Pearson, Gail D. ^{[14
]}

Wong, Pierre C. ^{[15
]}

Cohen, Meryl S. ^{[16
]}

机构：

[1] Med Coll Wisconsin, Milwaukee, WI 53226 USA

[2] New England Res Inst, Watertown, MA 02172 USA

[3] Alfred I DuPont Hosp Children, Wilmington, DE USA

[4] Emory Univ, Sch Med, Atlanta, GA USA

[5] Hosp Sick Children, Toronto, ON M5G 1X8, Canada

[6] Boston Childrens Hosp, Boston, MA USA

[7] Cincinnati Childrens Hosp, Cincinnati, OH USA

[8] Congenital Heart Inst Florida, Tampa, FL USA

[9] Columbia Univ, Med Ctr, New York, NY USA

[10] Univ Michigan, Ann Arbor, MI 48109 USA

[11] Univ Utah, Salt Lake City, UT USA

[12] Duke Univ, Durham, NC USA

[13] Med Univ S Carolina, Charleston, SC 29425 USA

[14] NHLBI, Bethesda, MD 20892 USA

[15] Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA

[16] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

来源：

JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY | 2013年 / 26卷 / 05期

关键词：

Hypoplastic left heart syndrome; Norwood; Echocardiography; Single ventricle; LEFT-HEART SYNDROME; DIASTOLIC DURATION RATIO; NORWOOD PROCEDURE; RECONSTRUCTION TRIAL; 1ST-STAGE PALLIATION; FAILURE SECONDARY; CHILDREN; ECHOCARDIOGRAPHY; CARDIOMYOPATHY; MULTICENTER;

D O I：

10.1016/j.echo.2013.02.012

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：521 / 529

页数：9

共 19 条

[1] Usefulness of the Right Ventricular Systolic to Diastolic Duration Ratio to Predict Functional Capacity and Survival in Children With Pulmonary Arterial Hypertension [J].