Ultrasound assessment of mesenteric blood flow in neonates with hypoplastic left heart before and after hybrid palliation

Background: Altered mesenteric perfusion may be a contributor to the development of necrotising enterocolitis in patients with hypoplastic left heart syndrome. The goal of this study was to document mesenteric flow patterns in patients with hypoplastic left heart syndrome pre- and post-hybrid procedure. Methods: A prospective study on all patients with hypoplatic left heart syndrome undergoing the hybrid procedure was conducted. Doppler ultrasound analysis of the coeliac and superior mesenteric artery was performed. Results: A total of 13 patients were evaluated. There was a significant difference in the coeliac artery effective velocity-time intergral pre- and post-hybrid procedure (8.69 +/- 3.84 versus 12.51 +/- 4.95 cm, respectively). There were significant differences in the superior mesenteric artery antegrade velocity-time integral pre- and post-hybrid procedure (6.86 +/- 2.45 versus 10.52 +/- 2.64 cm, respectively) and superior mesenteric artery effective velocity-time integral pre-and post-hybrid procedure (6.22 +/- 2.68 versus 9.73 +/- 2.73 cm, respectively). There were no significant differences between the coeliac and superior mesenteric artery Doppler indices in the pre-hybrid procedure; there were, however, significant differences in the post-hybrid procedure between coeliac and superior mesenteric artery antegrade velocity-time integral (13.8 2 +/- 5.60 versus 10.52 +/- 2.64 cm, respectively) and effective velocity-time integral (13.04 +/- 4.71 versus 9.73 +/- 2.73 cm, respectively). Conclusion: Doppler mesenteric indices of perfusion improve in patients with hypoplastic left heart syndrome after the hybrid procedure; however, there appears to be preferential flow to the coeliac artery versus the superior mesenteric artery in these patients post-procedure.