Longitudinal analysis of systemic ventricular function and atrioventricular valve function after the Norwood procedure

Author:

Fetcu Stefan12ORCID,Osawa Takuya12,Klawonn Frank34,Schaeffer Thibault12,Röhlig Christoph5,Staehler Helena12ORCID,Di Padua Chiara12,Heinisch Paul Philipp12ORCID,Piber Nicole6,Hager Alfred5ORCID,Ewert Peter5ORCID,Hörer Jürgen12,Ono Masamichi12ORCID

Affiliation:

1. Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München , Munich, Germany

2. Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität , Munich, Germany

3. Department of Biostatistics, Helmholtz Center for Infection Research , Braunschweig, Germany

4. Department of Computer Science, Ostfalia University , Wolfenbüttel, Germany

5. Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München , Munich, Germany

6. Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München , Munich, Germany

Abstract

Abstract OBJECTIVES To evaluate longitudinal systemic ventricular function and atrioventricular valve regurgitation in patients after the neonatal Norwood procedure. METHODS Serial postoperative echocardiographic images before Fontan completion were assessed in neonates who underwent the Norwood procedure between 2001 and 2020. Ventricular function and atrioventricular valve regurgitation were compared between patients with modified Blalock–Taussig shunt and right ventricle to pulmonary artery conduit. RESULTS A total of 335 patients were identified including 273 hypoplastic left heart syndrome and 62 of its variants. Median age at Norwood was 8 (7–12) days. Modified Blalock–Taussig shunt was performed in 171 patients and the right ventricle to pulmonary artery conduit in 164 patients. Longitudinal ventricular function and atrioventricular valve regurgitation were evaluated using a total of 4352 echocardiograms. After the Norwood procedure, ventricular function was initially worse (1–30 days) but thereafter better (30 days to stage II) in the right ventricle to pulmonary artery conduit group (P < 0.001). After stage II, the ventricular function was inferior in the right ventricle to the pulmonary artery conduit group (P < 0.001). Atrioventricular valve regurgitation between the Norwood procedure and stage II was more frequent in the modified Blalock–Taussig shunt group (P < 0.001). After stage II, there was no significant difference in atrioventricular valve regurgitation between the groups (P = 0.171). CONCLUSIONS The effect of shunt type on haemodynamics after the Norwood procedure seems to vary according to the stage of palliation. After the Norwood, the modified Blalock–Taussig shunt is associated with poorer ventricular function and worse atrioventricular valve regurgitation compared to right ventricle to pulmonary artery conduit. Whereas, after stage II, modified Blalock–Taussig shunt is associated with better ventricular function and comparable atrioventricular valve regurgitation, compared to the right ventricle to pulmonary artery conduit.

Publisher

Oxford University Press (OUP)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. How to protect the right ventricle in hypoplastic left heart syndrome;European Journal of Cardio-Thoracic Surgery;2024-03-26

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