Clinical InvestigationEchocardiography in Neonates, Children, and Young AdultsImpact of Initial Norwood Shunt Type on Right Ventricular Deformation: The Single Ventricle Reconstruction Trial
Section snippets
Study Population
The SVR trial enrolled patients with single morphologic RV lesions undergoing the Norwood procedure at 15 centers in the United States and Canada between May 2005 and July 2008. Inclusion and exclusion criteria have been previously described.14 Protocol echocardiographic data were collected at specific intervals during the first year as well as at 14 months of age.14 All protocol echocardiograms were maintained at the echocardiography core laboratory at the Medical College of Wisconsin, and the
Results
The cohort included 275 survivors, with 174 (63%) male patients, with echocardiograms obtained at a mean age of 14.3 ± 1.2 months available for retrospective review. There were 129 MBTS and 146 RVPAS subjects. These groups were similar in gender distribution and age and had similar ejection fractions and percentage fractional area change (Table 1). Thirty-two subjects (12%) had inadequate endocardial display from both the SAX and A4C views for speckle-tracking and were excluded from analysis.
Discussion
In this report, we describe the first multicenter application of speckle-tracking echocardiographic technology for the analysis of RV performance in children with single RV anomalies. The 275 survivors randomized to either MBTS or RVPAS, who proceeded through initial staged repair, had no statistically significant differences in global or regional indices of RV deformation identified between shunt types at 14 months of age. This data set also provides important information on the range of
Conclusions
Speckle-tracking echocardiographic assessment of circumferential and longitudinal deformation indices is available for the majority of survivors at 14 months of age in the SVR cohort from 2D echocardiograms, even when imaging is not targeted to optimize the assessment of deformation. No significant shunt-related differences were identified, though there were trends of decreased global and regional circumferential anterior wall deformation in the RVPAS compared with the MBTS group that correlate
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Cited by (24)
Hypoplastic Left Heart Syndrome Across the Lifespan: Clinical Considerations for Care of the Fetus, Child, and Adult
2022, Canadian Journal of CardiologyCitation Excerpt :Serial monitoring of RV function with the use of echocardiography measures such as fractional area change, RV strain, and tricuspid annular plane systolic excursion can help in early detection and risk stratification.107,109-113 Although the initial selection of surgical strategy does not seem to have important impact on RV systolic function,105,114-119 strategies for medical preservation of the RV may be a promising avenue of future study. Recent data suggest that digoxin use in the interstage is associated with better survival, likely related to an effect of RV remodelling,120 but other potential medical therapies deserve similar exploration.
Cumulative In-Hospital Costs Associated With Single-Ventricle Palliation
2022, JACC: AdvancesImpact of Right Ventricular Geometry and Left Ventricular Hypertrophy on Right Ventricular Mechanics and Clinical Outcomes in Hypoplastic Left Heart Syndrome
2019, Journal of the American Society of EchocardiographyCitation Excerpt :As CPD or other types of delayed electrical activation with nonsimultaneous peak strains were not identified in any patient in this cohort, the observed regional functional inhomogeneity more likely reflects differences in contractile function or differences in regional wall stress perhaps due to the differing geometry. Our results are consistent with other HLHS studies that described reduced strain in the basal septum.13,17-20 Petko et al19 suggested that this phenomenon may be associated with hypertrophy of the hypoplastic LV.
Serial Assessment of Right Ventricular Strain in Hypoplastic Left Heart Syndrome: Deformation Imaging in Deformed Hearts
2019, Journal of the American Society of EchocardiographyHeart failure after the Norwood procedure: An analysis of the Single Ventricle Reconstruction Trial
2018, Journal of Heart and Lung TransplantationLong term survival of hypoplastic left heart syndrome infants: Meta-analysis comparing outcomes from the modified Blalock–Taussig shunt and the right ventricle to pulmonary artery shunt
2018, International Journal of CardiologyCitation Excerpt :The results of the search are shown in Fig. 1 as according to the PRISMA flow chart (Fig. 1). A total of 32 studies were selected for statistical synthesis including seven RCTs [8,19,21,28–31] and 25 retrospective cohort studies [6,9–12,15,16,18,20,32–47]. Of the RCTs, six were derived from the SVR and the data was thus collated accordingly without repetition.
This study was supported by grants from the National Heart, Lung, and Blood Institute (HL068269, HL068270, HL068279, HL068281, HL068285, HL068292, HL068290, HL068288, and HL085057). This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute.
Dr Benjamin W. Eidem served as guest editor for this report.