Impact of Initial Shunt Type on Cardiac Size and Function in Children With Single Right Ventricle Anomalies Before the Fontan Procedure The Single Ventricle Reconstruction Extension Trial

被引：55

作者：

Frommelt, Peter C. ^{[1
]}

Gerstenberger, Eric ^{[2
]}

Cnota, James F. ^{[3
]}

Cohen, Meryl S. ^{[4
]}

Gorentz, Jessica ^{[1
]}

Hill, Kevin D. ^{[5
]}

John, J. Blaine ^{[6
]}

Levine, Jami C. ^{[7
]}

Lu, Jimmy ^{[8
]}

Mahle, William T. ^{[9
]}

McCandless, Rachel T. ^{[10
]}

Mertens, Luc ^{[11
]}

Pearson, Gail D. ^{[12
]}

Spencer, Carolyn ^{[13
]}

Thacker, Deepika ^{[14
]}

Williams, Ismee A. ^{[15
]}

Wong, Pierre C. ^{[16
]}

Newburger, Jane W. ^{[7
]}

机构：

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

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

[3] Cincinnati Childrens Hosp, Cincinnati, OH USA

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

[5] Duke Univ, Durham, NC USA

[6] Congenital Heart Inst Florida Pediatrix, Tampa, FL USA

[7] Boston Childrens Hosp, Boston, MA USA

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

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

[10] Primary Childrens Med Ctr, Salt Lake City, UT USA

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

[12] NHLBI, NIH, Bethesda, MD 20892 USA

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

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

[15] Cornell Univ, Med Ctr, New York, NY 10021 USA

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

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2014年 / 64卷 / 19期

关键词：

echocardiography; hypoplastic left heart syndrome; Norwood; LEFT-HEART SYNDROME; PULMONARY-ARTERY CONDUIT; BLALOCK-TAUSSIG SHUNT; NORWOOD PROCEDURE; RISK-FACTORS; MORTALITY; TRANSPLANTATION; HEMODYNAMICS; PERFORMANCE; MULTICENTER;

D O I：

10.1016/j.jacc.2014.08.033

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND In children with single right ventricular (RV) anomalies, changes in RV size and function may be influenced by shunt type chosen at the time of the Norwood procedure. OBJECTIVES The study sought to identify shunt-related differences in echocardiographic findings at 14 months and <= 6 months pre-Fontan in survivors of the Norwood procedure. METHODS We compared 2-dimensional and Doppler echocardiographic indices of RV size and function, neo-aortic and tricuspid valve annulus dimensions and function, and aortic size and patency at 14.1 +/- 1.2 months and 33.6 +/- 9.6 months in subjects randomized to a Norwood procedure using either the modified Blalock-Taussig shunt (MBTS) or right ventricle to pulmonary artery shunt (RVPAS). RESULTS Acceptable echocardiograms were available at both time points in 240 subjects (114 MBTS, 126 RVPAS). At 14 months, all indices were similar between shunt groups. From the 14-month to pre-Fontan echocardiogram, the MBTS group had stable indexed RV volumes and ejection fraction, while the RVPAS group had increased RV end-systolic volume (p = 0.004) and decreased right ventricular ejection fraction (RVEF) (p = 0.004). From 14 months to pre-Fontan, the treatment groups were similar with respect to decline in indexed neo-aortic valve area, >mild neo-aortic valve regurgitation (<5% at each time), indexed tricuspid valve area, and >= moderate tricuspid valve regurgitation (<20% at each time). CONCLUSIONS Initial Norwood shunt type influences pre-Fontan RV remodeling during the second and third years of life in survivors with single RV anomalies, with greater RVEF deterioration after RVPAS. Encouragingly, other indices of RV function remain stable before Fontan regardless of shunt type. (Comparison of Two Types of Shunts in Infants with Single Ventricle Defect Undergoing Staged Reconstruction-Pediatric Heart Network; NCT00115934) (C) 2014 by the American College of Cardiology Foundation.

引用

页码：2026 / 2035

页数：10

共 21 条

[1] A contemporary comparison of the effect of shunt type in hypoplastic left heart syndrome on the hemodynamics and outcome at Fontan completion [J].