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Erschienen in: Pediatric Cardiology 2/2021

10.10.2020 | Original Article

Right Ventricular Remodeling in Hypoplastic Left Heart Syndrome is Minimally Impacted by Cardiopulmonary Bypass: A Comparison of Norwood vs. Hybrid

verfasst von: Kandice Mah, Jesus Serrano Lomelin, Timothy Colen, Edythe B. Tham, Lily Lin, Luke Eckersley, Jeffrey F. Smallhorn, Harald Becher, Luc Mertens, Nee Scze Khoo

Erschienen in: Pediatric Cardiology | Ausgabe 2/2021

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Abstract

Right ventricular (RV) remodeling in hypoplastic left heart syndrome (HLHS) begins prenatally and continues through staged palliations. However, it is unclear if the most marked observed remodeling post-Norwood is secondary to cardiopulmonary bypass (CPB) exposure or if it is an adaptation intrinsic to the systemic RV. This study aims to determine the impact of CPB on RV remodeling in HLHS. Echocardiograms of HLHS survivors undergoing stage 1 Norwood (n = 26) or Hybrid (n = 20) were analyzed at pre- and post-stage 1, pre- and post-bidirectional cavo-pulmonary anastomosis (BCPA), and pre-Fontan. RV fractional area change (FAC), vector velocity imaging for longitudinal & derived circumferential deformation (global radial shortening (GRS) = peak radial displacement/end-diastolic diameter), and deformation ratio (longitudinal/ circumferential) were assessed. Both groups had similar age, clinical status and functional parameters pre-stage 1. No difference in RV size and sphericity at any stage between groups. RVFAC was normal (> 35%) throughout for both groups. Both Norwood and Hybrid patients had increased GRS (p = 0.0001) post-stage 1 and corresponding unchanged longitudinal strain, resulting in decreased deformation ratio (greater relative RV circumferential contraction), p = 0.0001. Deformation ratio remained decreased in both groups in subsequent stages. Irrespective of timing of the first CPB exposure, both Norwood and Hybrid patients underwent similar RV remodeling, with relative increase in circumferential to longitudinal contraction soon after stage 1 palliation. The observed RV remodeling in HLHS survivors were minimally impacted by CPB.
Literatur
1.
Zurück zum Zitat Barber G, Helton G, Aglira BA, Chin AJ, Murphy JD, Pigott JD et al (1988) The significance of tricuspid regurgitation in hypoplastic left-heart syndrome. Am Heart J 116:1563–1567PubMedCrossRef Barber G, Helton G, Aglira BA, Chin AJ, Murphy JD, Pigott JD et al (1988) The significance of tricuspid regurgitation in hypoplastic left-heart syndrome. Am Heart J 116:1563–1567PubMedCrossRef
2.
Zurück zum Zitat Lin LQ, Conway J, Alvarez S et al (2018) Reduced right ventricular fractional area change, strain, and strain rate before bidirectional cavopulmonary anastomosis is associated with medium-term mortality for children with hypoplastic left heart syndrome. J Am Soc Echocardiogr 31:831–842PubMedCrossRef Lin LQ, Conway J, Alvarez S et al (2018) Reduced right ventricular fractional area change, strain, and strain rate before bidirectional cavopulmonary anastomosis is associated with medium-term mortality for children with hypoplastic left heart syndrome. J Am Soc Echocardiogr 31:831–842PubMedCrossRef
3.
Zurück zum Zitat Colquitt JL, Loar RQ, Morris SA et al (2019) Serial strain analysis identifies hypoplastic left heart syndrome infants at risk for cardiac morbidity and mortality: a pilot study. J Am Soc Echocardiogr 32:643–650PubMedCrossRef Colquitt JL, Loar RQ, Morris SA et al (2019) Serial strain analysis identifies hypoplastic left heart syndrome infants at risk for cardiac morbidity and mortality: a pilot study. J Am Soc Echocardiogr 32:643–650PubMedCrossRef
4.
Zurück zum Zitat Brooks PB, Khoo NS, Mackie AS et al (2012) Right ventricular function in fetal hypoplastic left heart syndrome. J Am Soc Echocardiogr 10:1068–1074CrossRef Brooks PB, Khoo NS, Mackie AS et al (2012) Right ventricular function in fetal hypoplastic left heart syndrome. J Am Soc Echocardiogr 10:1068–1074CrossRef
5.
Zurück zum Zitat Tham EB, Smallhorn JF, Kaneko S et al (2014) Insights into the evolution of myocardial dysfunction in the functionally single RV between staged palliations using speckle-tracking echocardiography. J Am Soc Echocardiogr 27:314–322PubMedCrossRef Tham EB, Smallhorn JF, Kaneko S et al (2014) Insights into the evolution of myocardial dysfunction in the functionally single RV between staged palliations using speckle-tracking echocardiography. J Am Soc Echocardiogr 27:314–322PubMedCrossRef
6.
Zurück zum Zitat Khoo NS, Smallhorn JF, Kaneko S et al (2011) Novel insights into RV adaptation and function in HLHS between the first 2 stages of surgical palliation. J Am Coll Cardiol 4:128–137CrossRef Khoo NS, Smallhorn JF, Kaneko S et al (2011) Novel insights into RV adaptation and function in HLHS between the first 2 stages of surgical palliation. J Am Coll Cardiol 4:128–137CrossRef
7.
Zurück zum Zitat Kaneko S, Khoo NS, Smallhorn JF et al (2012) Single RV have impaired systolic and diastolic function compared to those of left ventricular morphology. J Am Soc Echocardiogr 25:1222–1230PubMedCrossRef Kaneko S, Khoo NS, Smallhorn JF et al (2012) Single RV have impaired systolic and diastolic function compared to those of left ventricular morphology. J Am Soc Echocardiogr 25:1222–1230PubMedCrossRef
8.
Zurück zum Zitat Tan JL, Prati D, Gatzoulis MA et al (2007) The RV response to high afterload: comparison between atrial switch procedure, CCTGA, and idiopathic pulmonary arterial hypertension. Am Heart J 153:681–688PubMedCrossRef Tan JL, Prati D, Gatzoulis MA et al (2007) The RV response to high afterload: comparison between atrial switch procedure, CCTGA, and idiopathic pulmonary arterial hypertension. Am Heart J 153:681–688PubMedCrossRef
9.
Zurück zum Zitat Hauser M, Bengel FM, Hager A et al (2003) Impaired myocardial blood flow and coronary flow reserve of the anatomical right systemic ventricle in patients with ccTGA. Heart 89:1231–1235PubMedPubMedCentralCrossRef Hauser M, Bengel FM, Hager A et al (2003) Impaired myocardial blood flow and coronary flow reserve of the anatomical right systemic ventricle in patients with ccTGA. Heart 89:1231–1235PubMedPubMedCentralCrossRef
10.
Zurück zum Zitat Li Y, Xie M, Wang X et al (2015) Impaired right and left ventricular function in asymptomatic children with repaired tetralogy of Fallot by two-dimensional speckle tracking echocardiography study. Echocardiography 32:135–143PubMedCrossRef Li Y, Xie M, Wang X et al (2015) Impaired right and left ventricular function in asymptomatic children with repaired tetralogy of Fallot by two-dimensional speckle tracking echocardiography study. Echocardiography 32:135–143PubMedCrossRef
12.
Zurück zum Zitat Rabe-Hesketh S, Skrondal A (2008) Multilevel and longitudinal modeling using Stata, 2nd edn. Stata Press, USA Rabe-Hesketh S, Skrondal A (2008) Multilevel and longitudinal modeling using Stata, 2nd edn. Stata Press, USA
13.
Zurück zum Zitat Hamdan A, Thouet T, Sebastian K et al (2008) Regional right ventricular function and timing of contraction in healthy volunteers evaluated by strain-encoded MRI. J Magn Reson Imaging 28:1379–1385PubMedCrossRef Hamdan A, Thouet T, Sebastian K et al (2008) Regional right ventricular function and timing of contraction in healthy volunteers evaluated by strain-encoded MRI. J Magn Reson Imaging 28:1379–1385PubMedCrossRef
14.
Zurück zum Zitat Pettersen E, Helle-Valle T, Edvardsen T et al (2007) Contraction pattern of the systemic RV shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 49:2450–2456CrossRef Pettersen E, Helle-Valle T, Edvardsen T et al (2007) Contraction pattern of the systemic RV shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 49:2450–2456CrossRef
15.
Zurück zum Zitat Moceri P, Bouvier P, Baudouy D et al (2017) Cardiac remodelling amongst adults with various aetiologies of pulmonary arterial hypertension including Eisenmenger syndrome-implications on survival and the role of right ventricular transverse strain. Eur Heart J Cardiovasc Imaging 18:1262–1270PubMedCrossRef Moceri P, Bouvier P, Baudouy D et al (2017) Cardiac remodelling amongst adults with various aetiologies of pulmonary arterial hypertension including Eisenmenger syndrome-implications on survival and the role of right ventricular transverse strain. Eur Heart J Cardiovasc Imaging 18:1262–1270PubMedCrossRef
16.
Zurück zum Zitat Friedberg MK, Silverman NH, Dubin AM et al (2007) RV mechanical dyssynchrony in children with HLHS. J Am Soc Echocardiogr 20:1073–1079PubMedCrossRef Friedberg MK, Silverman NH, Dubin AM et al (2007) RV mechanical dyssynchrony in children with HLHS. J Am Soc Echocardiogr 20:1073–1079PubMedCrossRef
17.
Zurück zum Zitat Monivas Palomero V, Mingo Santos S, Goirigolzarri Artaza J et al (2016) Two-dimensional speckle tracking echocardiography in heart transplant patients: two-year follow-up of right and left ventricular function. Echocardiography 33:703–713PubMedCrossRef Monivas Palomero V, Mingo Santos S, Goirigolzarri Artaza J et al (2016) Two-dimensional speckle tracking echocardiography in heart transplant patients: two-year follow-up of right and left ventricular function. Echocardiography 33:703–713PubMedCrossRef
18.
Zurück zum Zitat Lopaschuk GD, Collins-Nakai R, Olley M et al (1994) Plasma fatty acid levels in infants and adults after myocardial ischemia. Am Heart J 128:61–67PubMedCrossRef Lopaschuk GD, Collins-Nakai R, Olley M et al (1994) Plasma fatty acid levels in infants and adults after myocardial ischemia. Am Heart J 128:61–67PubMedCrossRef
19.
Zurück zum Zitat Kantor P, Dyck J, Lopaschuk G (1999) Fatty acid oxidation in the reperfused ischemic heart. Am J Med Sci 318:3–27PubMedCrossRef Kantor P, Dyck J, Lopaschuk G (1999) Fatty acid oxidation in the reperfused ischemic heart. Am J Med Sci 318:3–27PubMedCrossRef
20.
Zurück zum Zitat Karimi M, Wang LX, Hammel JM et al (2004) Neonatal vulnerability to ischemia and reperfusion: cardioplegic arrest causes greater myocardial apoptosis in neonatal lambs than in mature lambs. J Thorac Cardiovasc Surg 127:490–497PubMedCrossRef Karimi M, Wang LX, Hammel JM et al (2004) Neonatal vulnerability to ischemia and reperfusion: cardioplegic arrest causes greater myocardial apoptosis in neonatal lambs than in mature lambs. J Thorac Cardiovasc Surg 127:490–497PubMedCrossRef
21.
Zurück zum Zitat Van Arsdell G, Maharaj G, Tom J et al (2000) What is the optimal age for repair of Tetralogy of Fallot? Circulation 102:123–129CrossRef Van Arsdell G, Maharaj G, Tom J et al (2000) What is the optimal age for repair of Tetralogy of Fallot? Circulation 102:123–129CrossRef
22.
Zurück zum Zitat Grotenhuis HB, Ruijsink B, Chetan D et al (2016) Impact of Norwood versus hybrid palliation on cardiac size and function in HLHS. Heart 102:966–974PubMedCrossRef Grotenhuis HB, Ruijsink B, Chetan D et al (2016) Impact of Norwood versus hybrid palliation on cardiac size and function in HLHS. Heart 102:966–974PubMedCrossRef
23.
Zurück zum Zitat Fischbach J, Sinzobahamvya N, Haun C et al (2013) Interventions after Norwood procedure: comparison of Sano and modified BT-shunt. Pediatr Cardiol 34:112–118PubMedCrossRef Fischbach J, Sinzobahamvya N, Haun C et al (2013) Interventions after Norwood procedure: comparison of Sano and modified BT-shunt. Pediatr Cardiol 34:112–118PubMedCrossRef
24.
Zurück zum Zitat Photiadis J, Sinzobahamvya N, Haun C et al (2012) Does the shunt type determine mid-term outcome after Norwood operation? Eur J Cardio-Thorac Surg 42:209–216CrossRef Photiadis J, Sinzobahamvya N, Haun C et al (2012) Does the shunt type determine mid-term outcome after Norwood operation? Eur J Cardio-Thorac Surg 42:209–216CrossRef
25.
Zurück zum Zitat Padalino MA, Castellani C, Toffoli S et al (2008) Pathological changes and myocardial remodelling related to the mode of shunting following surgical palliation for HLHS. Cardiol Young 18:415–422PubMedCrossRef Padalino MA, Castellani C, Toffoli S et al (2008) Pathological changes and myocardial remodelling related to the mode of shunting following surgical palliation for HLHS. Cardiol Young 18:415–422PubMedCrossRef
26.
Zurück zum Zitat Kutty S, Graney BA, Khoo NS et al (2012) Serial assessment of right ventricular volume and function in surgically palliated HLHS using real-time transthoracic 3D echocardiography. J Am Soc Echocardiogr 25:682–689PubMedCrossRef Kutty S, Graney BA, Khoo NS et al (2012) Serial assessment of right ventricular volume and function in surgically palliated HLHS using real-time transthoracic 3D echocardiography. J Am Soc Echocardiogr 25:682–689PubMedCrossRef
27.
Zurück zum Zitat Piran S (2002) Heart failure and ventricular dysfunction in patients with single or systemic RV. Circulation 105:1189–1194PubMedCrossRef Piran S (2002) Heart failure and ventricular dysfunction in patients with single or systemic RV. Circulation 105:1189–1194PubMedCrossRef
Metadaten
Titel
Right Ventricular Remodeling in Hypoplastic Left Heart Syndrome is Minimally Impacted by Cardiopulmonary Bypass: A Comparison of Norwood vs. Hybrid
verfasst von
Kandice Mah
Jesus Serrano Lomelin
Timothy Colen
Edythe B. Tham
Lily Lin
Luke Eckersley
Jeffrey F. Smallhorn
Harald Becher
Luc Mertens
Nee Scze Khoo
Publikationsdatum
10.10.2020
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 2/2021
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-020-02482-0

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