Journal article

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


Authors listLatus, 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

Publication year2018

Pages244-252

JournalHeart

Volume number104

Issue number3

ISSN1355-6037

eISSN1468-201X

Open access statusGreen

DOI Linkhttps://doi.org/10.1136/heartjnl-2017-311532

PublisherBMJ Publishing Group


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 mm(2)/m(2), 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.




Citation Styles

Harvard Citation styleLatus, H., Nassar, M., Wong, J., Hachmann, P., Bellsham-Revell, H., Hussain, T., et al. (2018) Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome, Heart, 104(3), pp. 244-252. https://doi.org/10.1136/heartjnl-2017-311532

APA Citation styleLatus, H., Nassar, M., 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. 104(3), 244-252. https://doi.org/10.1136/heartjnl-2017-311532



Keywords


3 TESLACARDIAC SIZEGRADIENT-ECHOINTERVENTIONSOPERATIONSTATE FREE PRECESSIONSURGICAL PALLIATIONVOLUMES

Last updated on 2025-10-06 at 10:50