Journal of the American Society of Echocardiography
Clinical InvestigationCongenital Heart DiseaseChanges of Right Ventricular Function and Longitudinal Deformation in Children with Hypoplastic Left Heart Syndrome before and after the Norwood Operation
Section snippets
Patients
A retrospective database search identified 45 children with HLHS who underwent modified Norwood operations at our institution from February 2008 to September 2010. Of these, 33 fulfilled our inclusion criteria of (1) having echocardiographic data suitable for speckle-tracking analysis of the right ventricle available before and after surgery and (2) being hemodynamically stable at the time of preoperative and postoperative echocardiography, without the need for mechanical ventilation or
Results
Pertinent patient data are shown in Table 1. MA/AA was present in 19 patients (58%), MS/AS in six (18%), and MS/AA in eight (24%). MA/AS did not occur in our study population. Twenty-one patients (64%) were male.
The diagnosis was made prenatally in 23 patients (70%). Preoperative ventilation was necessary in five patients (15%); preoperative complications occurred in eight patients (24%) and included cardiovascular shock with necessity for resuscitation in four patients (18%), a cerebrovascular
Discussion
Our study showed that longitudinal RV deformation assessed by 2D speckle tracking and TAPSE were lower at a median time of 21 days after the Norwood operation compared with preoperative values under otherwise stable clinical conditions. The right ventricle was larger in both systole and diastole, so that RVFAC, an indicator of global function, did not change. Factors such as cardiopulmonary bypass time, aortic cross-clamp time, postoperative heart rate or oxygen saturation, the anatomic subtype
Conclusions
Longitudinal RV deformation and TAPSE were lower at a median of 21 days after the Norwood operation compared with preoperative values. No single factor among those we investigated was able to explain our findings, and thus our findings are mostly descriptive and may serve for future comparison in similar patient populations. The etiology of the decrease in longitudinal RV function remains speculative, and therefore, prospective, longitudinal studies using a specified imaging protocol should be
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Dr. Petko was supported by the nonprofit organization Kinderherzen Wollen Leben e.V. (Kiel, Germany).