1
|
Cunningham TW, Bai S, Krawczeski CD, Spencer JD, Phelps C, Yates AR. Acute kidney injury in hypoplastic left heart syndrome patients following the comprehensive stage two palliation. Cardiol Young 2024; 34:552-558. [PMID: 37565360 DOI: 10.1017/s1047951123002974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND An alternative surgical approach for hypoplastic left heart syndrome is the Hybrid pathway, which delays the risk of acute kidney injury outside of the newborn period. We sought to determine the incidence, and associated morbidity, of acute kidney injury after the comprehensive stage 2 and the cumulative incidence after the first two operations in the Hybrid pathway. DESIGN A single centre, retrospective study was conducted of hypoplastic left heart patients completing the second-stage palliation in the Hybrid pathway from 2009 to 2018. Acute kidney injury was defined utilising Kidney Diseases Improving Global Outcomes criteria. Perioperative and post-operative characteristics were analysed. RESULTS Sixty-one patients were included in the study cohort. The incidence of acute kidney injury was 63.9%, with 36.1% developing severe injury. Cumulatively after the Hybrid Stage 1 and comprehensive stage 2 procedures, 69% developed acute kidney injury with 36% developing severe injury. The presence of post-operative acute kidney injury was not associated with an increase in 30-day mortality (acute kidney injury 7.7% versus none 9.1%; p = > 0.9). There was a significantly longer median duration of intubation among those with acute kidney injury (acute kidney injury 32 (8, 155) hours vs. no injury 9 (0, 94) hours; p = 0.018). CONCLUSIONS Acute kidney injury after the comprehensive stage two procedure is common and accounts for most of the kidney injury in the first two operations of the Hybrid pathway. No difference in mortality was detected between those with acute kidney injury and those without, although there may be an increase in morbidity.
Collapse
Affiliation(s)
- Tyler W Cunningham
- Department of Pediatrics, Section of Cardiology and Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Shasha Bai
- Pediatric Biostatistics, Emory University, Atlanta, GA, USA
| | | | - John D Spencer
- Section of Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christina Phelps
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrew R Yates
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
2
|
Beattie MJ, Sleeper LA, Lu M, Teele SA, Breitbart RE, Esch JJ, Salvin JW, Kapoor U, Oladunjoye O, Emani SM, Banka P. Factors associated with morbidity, mortality, and hemodynamic failure after biventricular conversion in borderline hypoplastic left hearts. J Thorac Cardiovasc Surg 2023; 166:933-942.e3. [PMID: 36803549 DOI: 10.1016/j.jtcvs.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE A subset of patients with borderline hypoplastic left heart may be candidates for single to biventricular conversion, but long-term morbidity and mortality persist. Prior studies have shown conflicting results regarding the association of preoperative diastolic dysfunction and outcome, and patient selection remains challenging. METHODS Patients with borderline hypoplastic left heart undergoing biventricular conversion from 2005 to 2017 were included. Cox regression identified preoperative factors associated with a composite outcome of time to mortality, heart transplant, takedown to single ventricle circulation, or hemodynamic failure (defined as left ventricular end-diastolic pressure >20 mm Hg, mean pulmonary artery pressure >35 mm Hg, or pulmonary vascular resistance >6 international Woods units). RESULTS Among 43 patients, 20 (46%) met the outcome, with a median time to outcome of 5.2 years. On univariate analysis, endocardial fibroelastosis, lower left ventricular end-diastolic volume/body surface area (when <50 mL/m2), lower left ventricular stroke volume/body surface area (when <32 mL/m2), and lower left:right ventricular stroke volume ratio (when <0.7) were associated with outcome; higher preoperative left ventricular end-diastolic pressure was not. Multivariable analysis demonstrated that endocardial fibroelastosis (hazard ratio, 5.1, 95% confidence interval, 1.5-22.7, P = .033) and left ventricular stroke volume/body surface area 28 mL/m2 or less (hazard ratio, 4.3, 95% confidence interval, 1.5-12.3, P = .006) were independently associated with a higher hazard of the outcome. Approximately all patients (86%) with endocardial fibroelastosis and left ventricular stroke volume/body surface area 28 mL/m2 or less met the outcome compared with 10% of those without endocardial fibroelastosis and with higher stroke volume/body surface area. CONCLUSIONS History of endocardial fibroelastosis and smaller left ventricular stroke volume/body surface area are independent factors associated with adverse outcomes among patients with borderline hypoplastic left heart undergoing biventricular conversion. Normal preoperative left ventricular end-diastolic pressure is insufficient to reassure against diastolic dysfunction after biventricular conversion.
Collapse
Affiliation(s)
- Meaghan J Beattie
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Sarah A Teele
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Roger E Breitbart
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Jesse J Esch
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Joshua W Salvin
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Urvi Kapoor
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Olubunmi Oladunjoye
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass
| | - Sitaram M Emani
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass
| | - Puja Banka
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| |
Collapse
|
3
|
Argo MB, Barron DJ, Eghtesady P, Alsoufi B, Honjo O, Yerebakan C, DeCampli WM, Jacobs JP, Carrillo SA, Jegatheeswaran A, Karamlou T, Paramananthan T, Rahman M, Lambert LM, Nelson J, Caldarone CA, Husain SA, Galantowicz ME, Ramakrishnan K, Kirklin JK, Turek JW, Mannie C, Blackstone EH, Mitchell ME, McCrindle BW. Norwood operation versus comprehensive stage II after bilateral pulmonary artery banding palliation for infants with critical left heart obstruction. J Thorac Cardiovasc Surg 2023; 166:943-954.e1. [PMID: 36804212 DOI: 10.1016/j.jtcvs.2023.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/15/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine patient characteristics and outcomes after Norwood versus comprehensive stage II (COMPSII) for infants with critical left heart obstruction who had prior hybrid palliation (bilateral pulmonary artery banding ± ductal stent). METHODS From 23 Congenital Heart Surgeons' Society institutions (2005-2020), 138 infants underwent hybrid palliation followed by either Norwood (n = 73, 53%) or COMPSII (n = 65). Baseline characteristics were compared between Norwood and COMPSII groups. Parametric hazard model with competing risk methodology was used to determine risk and factors associated with outcomes of Fontan, transplantation, or death. RESULTS Infants who underwent Norwood versus COMPSII had a higher prevalence of prematurity (26% vs 14%, P = .08), lower birth weight (median 2.8 vs 3.2 kg, P < .01) and less frequent ductal stenting (37% vs 99%; P < .01). Norwood was performed at a median age of 44 days and median weight of 3.5 kg, versus COMPSII at 162 days and 6.0 kg (both P < .01). Median follow-up was 6.5 years. At 5 years after Norwood and COMPSII, respectively; 50% versus 68% had Fontan (P = .16), 3% versus 5% had transplantation (P = .70), 40% versus 15% died (P = .10), and 7% versus 11% are alive without transition, respectively. For factors associated with either mortality or Fontan, only preoperative mechanical ventilation occurred more frequently in the Norwood group. CONCLUSIONS Higher prevalence of prematurity, lower birth weight, and other patient-related characteristics in the Norwood versus COMPSII groups may influence differences in outcomes that were not statistically significant for this limited risk-adjusted cohort. The clinical decision regarding Norwood versus COMPSII after initial hybrid palliation remains challenging.
Collapse
Affiliation(s)
- Madison B Argo
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wis; Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David J Barron
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, St. Louis, Mo
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, Norton Children's Hospital, Louisville, Ky
| | - Osami Honjo
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Can Yerebakan
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Sergio A Carrillo
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Anusha Jegatheeswaran
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tharini Paramananthan
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maha Rahman
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda M Lambert
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Jennifer Nelson
- Division of Pediatric Cardiovascular Surgery, Children's Mercy Kansas City, Kansas City, Mo
| | | | - S Adil Husain
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Mark E Galantowicz
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Karthik Ramakrishnan
- Division of Pediatric Cardiovascular Surgery, LeBonheur Children's Hospital, Memphis, Tenn
| | - James K Kirklin
- Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Ala
| | - Joseph W Turek
- Department of Surgery, Duke Children's Hospital and Health Center, Durham, NC
| | - Chelsea Mannie
- Division of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, St. Louis, Mo
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Children's Wisconsin, Milwaukee, Wis
| | - Brian W McCrindle
- Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| |
Collapse
|
4
|
Linnane N, Alshahrani D, Kenny DP, Walsh KP, McMahon CJ. Evolution in the management of aorta to left ventricular tunnel in a national congenital cardiology centre. Cardiol Young 2023; 33:1753-1756. [PMID: 36991559 DOI: 10.1017/s1047951123000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
An aorto-ventricular tunnel is a rare congenital cardiac defect, where a channel connects the lumen of the ascending aorta to the left or right ventricle. Four patients presented with an aorto-left ventricular tunnel over two decades at a median age of 8 months (range 0.1-10 months). Two patients (50%) had associated cardiac anomalies including hypoplastic left heart syndrome and left ventricular noncompaction/hypertrophic cardiomyopathy with aortic/pulmonary valve dysplasia in one patient each. Although traditionally surgical treatment has addressed this problem, management has evolved to transcatheter closure with excellent outcomes in appropriately selected patients at our national centre.
Collapse
Affiliation(s)
- N Linnane
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin12, Ireland
| | - D Alshahrani
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin12, Ireland
- Section of Paediatric Cardiology, King Abdulaziz Medical City, Department of Cardiac Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - D P Kenny
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin12, Ireland
| | - K P Walsh
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin12, Ireland
| | - C J McMahon
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin12, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin4, Ireland
- Maastricht School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
5
|
Milligan C, Mills KI, Ge S, Michalowski A, Braudis N, Mansfield L, Nathan M, Sleeper LA, Teele SA. Cardiovascular intensive care unit variables inform need for feeding tube utilization in infants with hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2023; 165:1248-1256. [PMID: 35691711 DOI: 10.1016/j.jtcvs.2022.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/24/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Feeding strategies in infants with hypoplastic left heart syndrome (HLHS) following stage 1 palliation (S1P) include feeding tube utilization (FTU). Timely identification of infants who will fail oral feeding could mitigate morbidity in this vulnerable population. We aimed to develop a novel clinical risk prediction score for FTU. METHODS This was a retrospective study of infants with HLHS admitted to the Boston Children's Hospital cardiovascular intensive care unit for S1P from 2009 to 2019. Infants discharged with feeding tubes were compared with those on full oral feeds. Variables from early (birth to surgery), mid (postsurgery to cardiovascular intensive care unit transfer), and late (inpatient transfer to discharge) hospitalization were analyzed in univariate and multivariable models. RESULTS Of 180 infants, 66 (36.7%) discharged with a feeding tube. In univariate analyses, presence of a genetic disorder (early variable, odds ratio, 3.25; P = .014) and nearly all mid and late variables were associated with FTU. In the mid multivariable model, abnormal head imaging, ventilation duration, and vocal cord dysfunction were independent predictors of FTU (c-statistic 0.87). Addition of late variables minimally improved the model (c-statistic 0.91). A risk score (the HV2 score) for FTU was developed based on the mid multivariable model with high specificity (93%). CONCLUSIONS Abnormal head imaging, duration of ventilation, and presence of vocal cord dysfunction were associated with FTU in infants with HLHS following S1P. The predictive HV2 risk score supports routine perioperative head imaging and vocal cord evaluation. Future application of the HV2 score may improve nutritional morbidity and hospital length of stay in this population.
Collapse
Affiliation(s)
- Caitlin Milligan
- Department of Cardiology, Boston Children's Hospital, Boston, Mass.
| | - Kimberly I Mills
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Shirley Ge
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Anna Michalowski
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Nancy Braudis
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - Laura Mansfield
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Surgery, Harvard Medical School, Boston, Mass
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Sarah A Teele
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| |
Collapse
|
6
|
Mah K, Khoo NS, Martin BJ, Maruyama M, Alvarez S, Rebeyka IM, Smallhorn J, Colen T. Insights from 3D Echocardiography in Hypoplastic Left Heart Syndrome Patients Undergoing TV Repair. Pediatr Cardiol 2022; 43:735-743. [PMID: 34812910 DOI: 10.1007/s00246-021-02780-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) in hypoplastic left heart syndrome (HLHS) is associated with morbidity and mortality. TR mechanisms and the impact of tricuspid valve repair (TVR) are unclear. We examined HLHS TR mechanisms, TVR's impact on tricuspid valve (TV), and features of poor TVR durability. METHODS We retrospectively compared 35 HLHS TVR cases and 35 age/stage-matched HLHS controls who do not undergo TVR. Pre-operative 3-dimensional echocardiography (3DE) assessed overall TV morphology (prolapse, normal, tethered), leaflet morphology, vena contracta area, and TR location. Two-dimensional echocardiography measured TV annulus diameter, RV fractional area change (RVFAC), sphericity, and TR grade at three time points (pre-op, early post-op, and latest follow-up). RESULTS Pre-op, TVR group, and controls had no difference in age, RV function or shape, or TV dimension. TVR group most commonly had anterior leaflet prolapse followed by septal leaflet prolapse or tethering. TR jet arises centrally (63%) and anterior septally (26%). Posterior annuloplasty (69%), commissuroplasty (37%), and leaflet repair (37%) were surgical techniques commonly performed. At early post-op, TR grade and TV annulus decreased. At latest follow-up, TV annulus remained reduced; however, 50% had significant TR. 25% required TV reoperation. Larger vena contracta at TVR was associated with significant TR. CONCLUSION HLHS patients undergoing TVR had more anterior leaflet prolapse and central TR. While TVR initially reduces annular size and TR grade, 50% redevelop significant TR despite maintained annular reduction. The association of greater TR severity prior to repair with post-op recurrence raises the consideration for earlier repair of TR in HLHS patients.
Collapse
Affiliation(s)
- Kandice Mah
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada
| | - Nee Scze Khoo
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada
| | - Billie-Jean Martin
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, USA
| | - Michiko Maruyama
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Silvia Alvarez
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada
| | - Ivan M Rebeyka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey Smallhorn
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada
| | - Timothy Colen
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada.
| |
Collapse
|
7
|
Wilkes JK, Doan TT, Morris SA, Altman CA, Ayres NA, Schoppe L, Nguyen M, Pignatelli R, Furtun BY. Right Ventricular Global Longitudinal Strain in Fetuses with Hypoplastic Left Heart Syndrome Does Not Differ Between Those With and Without Genetic Conditions. Pediatr Cardiol 2022; 43:655-664. [PMID: 34812908 DOI: 10.1007/s00246-021-02770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
The presence of a genetic condition is a risk factor for increased mortality in hypoplastic left heart syndrome (HLHS). Speckle tracking strain analysis in interstage echocardiograms have shown promise in identifying patients with HLHS at increased risk of mortality. We hypothesized that fetuses with a genetic condition and HLHS have impaired right ventricular global longitudinal strain compared with fetuses with HLHS and no evident genetic condition. We performed a retrospective analysis of 60 patients diagnosed in fetal life with HLHS from 11/2015 to 11/2019. We evaluated presenting echocardiograms and calculated right ventricular global longitudinal strain (RV GLS) and fractional area of change (FAC) using post-processing software. We first compared RV GLS and FAC between those with genetic conditions to those without. We examined the secondary outcome of mortality among those with and without genetic conditions and among HLHS subgroups. Of the 60 patients with available genetic testing, 11 (18%) had an identified genetic condition. Neither RV GLS nor FAC was significantly different between patients with and without genetic conditions. There was no difference in RV GLS or FAC among HLHS phenotype or those who died or survived as infants. However, patients with a genetic syndrome had increased neonatal and overall mortality. In this cohort, RV GLS did not differ between those with and without a genetic diagnosis, among HLHS phenotypes, or between those surviving and dying as infants. Further analysis of strain throughout gestation and after birth could provide insight into the developing heart in fetuses with HLHS.
Collapse
Affiliation(s)
- J Kevin Wilkes
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA.
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, E1920, Houston, TX, 77030, USA.
| | - Tam T Doan
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| | - Shaine A Morris
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| | - Carolyn A Altman
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| | - Nancy A Ayres
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| | - Lacey Schoppe
- Texas Children's Hospital Fetal Center, 6651 Main St, Suite 420, Houston, TX, 77030, USA
| | - Magnolia Nguyen
- Texas Children's Hospital Fetal Center, 6651 Main St, Suite 420, Houston, TX, 77030, USA
| | - Ricardo Pignatelli
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| | - Betul Yilmaz Furtun
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6651 Main St, FE1920, Houston, TX, 77030, USA
| |
Collapse
|
8
|
Iwai S, Miwa K, Nagashima T. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 34:930-932. [PMID: 35137109 PMCID: PMC9070487 DOI: 10.1093/icvts/ivac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/08/2021] [Accepted: 01/02/2022] [Indexed: 11/14/2022] Open
Abstract
Association between hypoplastic left heart syndrome and valvular pulmonary stenosis is very rare. Severity of valvular pulmonary stenosis in this setting limits management options. Consequently, patients with this condition are considered poor candidates for Norwood stage one reconstruction. Herein, we describe a newborn with hypoplastic left heart syndrome and significantly dysplastic pulmonary valve who successfully underwent the Norwood procedure with neoaortic valve reconstruction. Therefore, the Norwood procedure with neoaortic valve reconstruction might be an option for this difficult condition.
Collapse
Affiliation(s)
- Shigemitsu Iwai
- Department of Cardiovascular Surgery, Osaka Women’s and Children’s Hospital, Osaka, Japan
- Corresponding author. Department of Cardiovascular Surgery, Osaka Women’s and Children’s Hospital, 840 Murodocho, Izumi, Osaka 594-1101, Japan. Tel: +81-725-56-1220; fax: +81-725-56-5682; e-mail: (S. Iwai)
| | - Koji Miwa
- Department of Cardiovascular Surgery, Osaka Women’s and Children’s Hospital, Osaka, Japan
| | - Toshiaki Nagashima
- Department of Cardiovascular Surgery, Osaka Women’s and Children’s Hospital, Osaka, Japan
| |
Collapse
|
9
|
Peyvandi S, Lim JM, Marini D, Xu D, Reddy VM, Barkovich AJ, Miller S, McQuillen P, Seed M. Fetal brain growth and risk of postnatal white matter injury in critical congenital heart disease. J Thorac Cardiovasc Surg 2021; 162:1007-1014.e1. [PMID: 33185192 PMCID: PMC8012393 DOI: 10.1016/j.jtcvs.2020.09.096] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test the hypothesis that delayed brain development in fetuses with d-transposition of the great arteries or hypoplastic left heart syndrome heightens their postnatal susceptibility to acquired white matter injury. METHODS This is a cohort study across 3 sites. Subjects underwent fetal (third trimester) and neonatal preoperative magnetic resonance imaging of the brain to measure total brain volume as a measure of brain maturity and the presence of acquired white matter injury after birth. White matter injury was categorized as no-mild or moderate-severe based on validated grading criteria. Comparisons were made between the injury groups. RESULTS A total of 63 subjects were enrolled (d-transposition of the great arteries: 37; hypoplastic left heart syndrome: 26). White matter injury was present in 32.4% (n = 12) of d-transposition of the great arteries and 34.6% (n = 8) of those with hypoplastic left heart syndrome. Overall total brain volume (taking into account fetal and neonatal scan) was significantly lower in those with postnatal moderate-severe white matter injury compared with no-mild white matter injury after adjusting for age at scan and site in d-transposition of the great arteries (coefficient: 14.8 mL, 95% confidence interval, -28.8 to -0.73, P = .04). The rate of change in total brain volume from fetal to postnatal life did not differ by injury group. In hypoplastic left heart syndrome, no association was noted between overall total brain volume and change in total brain volume with postnatal white matter injury. CONCLUSIONS Lower total brain volume beginning in late gestation is associated with increased risk of postnatal moderate-severe white matter injury in d-transposition of the great arteries but not hypoplastic left heart syndrome. Rate of brain growth was not a risk factor for white matter injury. The underlying fetal and perinatal physiology has different implications for postnatal risk of white matter injury.
Collapse
Affiliation(s)
- Shabnam Peyvandi
- Department of Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif.
| | - Jessie Mei Lim
- Department of Pediatrics, University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Davide Marini
- Department of Pediatrics, University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Duan Xu
- Department of Radiology, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif
| | - V Mohan Reddy
- Department of Surgery, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif
| | - A James Barkovich
- Department of Radiology, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif
| | - Steven Miller
- Department of Neurology, University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patrick McQuillen
- Department of Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, Calif
| | - Mike Seed
- Department of Pediatrics, University of Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Papneja K, Laks J, Szabo AB, Grosse-Wortmann L. Low descending aorta flow is associated with adverse feeding outcomes in neonates with small left-sided structures. Int J Cardiovasc Imaging 2020; 37:269-273. [PMID: 32740880 DOI: 10.1007/s10554-020-01958-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022]
Abstract
Feeding intolerance and necrotizing enterocolitis (NEC) cause significant morbidity in neonates with duct-dependent systemic circulations. Whether these complications are associated with low blood flow to the bowel is unproven. The aim of this study was to determine whether low descending aortic (DAO) flow is associated with adverse feeding outcomes in neonates with small left-sided structures, including borderline left ventricle and hypoplastic left heart syndrome (HLHS). The cardiac magnetic resonance (CMR) imaging studies and abdominal Doppler ultrasound profiles prior to any cardiac interventions in neonates with small left-sided structures were analyzed. Descending aortic flows, indexed to body surface area, were collected. Medical charts were reviewed for a composite outcome of feeding intolerance and/or NEC. Among the 51 enrolled study patients (mean age 4.6, SD 4.5 days), 13 experienced the composite outcome (feeding intolerance in 13, NEC in 2). The mean DAO flow in patients who experienced the composite outcome was 0.89 L/min/m2 (SD 0.33 L/min/m2), compared to 1.23 L/min/m2 (SD 0.41 L/min/m2) in those that did not (p = 0.007). A DAO flow of 0.91 L/min/m2 identified patients who experienced feeding intolerance or NEC with a sensitivity of 61% and a specificity of 76%. Doppler ultrasound metrics of DAO flow did not correlate with DAO flow or predict adverse feeding outcomes. Low DAO flow is associated with adverse outcomes, including feeding intolerance and NEC, in neonates with small left-sided structures. Heightened clinical vigilance towards feeding complications in patients with low DAO flow is recommended.
Collapse
Affiliation(s)
- Koyelle Papneja
- The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Jessica Laks
- The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adrienn B Szabo
- The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
- Division of Cardiology, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, ORE, USA.
| |
Collapse
|
11
|
Binkley M, Kelly M, Hardy K. Cerebral arterial gas embolism in a patient with hypoplastic left heart syndrome treated with emergent hyperbaric oxygen: case report. Undersea Hyperb Med 2020; 47:431-434. [PMID: 32931669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 30-year-old female with a history of seizure disorder and hypoplastic left heart syndrome treated with a Norwood procedure in 1986 followed by a modified non-fenestrated Fontan (Left SVC to IVC to pulmonary arteries) with a known baffle leak presented to the emergency department. On day of presentation, the patient became unresponsive, with perioral cyanosis, rightward gaze and a left facial droop near the end of a platelet transfusion. An emergent non-contrast head CT revealed intracranial air in the right MCA distribution. She was taken to the hyperbaric chamber and was treated with a U.S. Navy Table 6 in a multiplace chamber with no extensions. Ten minutes into the treatment patient became more alert and spontaneously asked questions. The following day she was treated with a U.S. Navy Table 5. Patient had repeat CT of the head, which showed resolution of intracerebral gas and small areas of ischemia in right frontal lobe and right caudate. On hospital day five neurologic exam was normal, with 5/5 strength and no residual deficits. Treating the patient was a concern because patient has a single ventricle, in which the pulmonary artery is connected directly to the vena cava. There is very little data regarding the effects of hyperbaric oxygen (HBO2)therapy on single-ventricle physiology. Only two case reports of three pediatric patients treated with HBO2 for CAGE in a similar setting are known. In these cases the patients had improvements in their symptoms following HBO2. These cases and ours indicate HBO2 is feasible and indicated for CAGE in patients with cyanotic congenital heart disease.
Collapse
Affiliation(s)
- Mark Binkley
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania U.S
| | - Matthew Kelly
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania U.S
| | - Kevin Hardy
- Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania U.S
| |
Collapse
|
12
|
Penk J, Mukadam S, Zaidi SJ, Cui V, Metzger R, Roberson DA, Li Y. Comparison of Semi-Automated Versus Manual Quantitative Right Ventricular Assessment in Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2020; 41:69-76. [PMID: 31659391 DOI: 10.1007/s00246-019-02223-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/15/2019] [Indexed: 11/26/2022]
Abstract
Quantitative echocardiographic evaluation is important for systemic right ventricles, but its asymmetric shape makes this challenging and time consuming when performed manually. Semi-automated software could make these quantitative measures easier to accomplish in the clinical setting. We hypothesized that semi-automated software would approximate manual measures of right ventricular size and function. Children with hypoplastic left heart who had echocardiograms were prospectively identified. These measurements were performed using manual and semi-automated techniques: end-diastolic and end-systolic area, fractional area change (FAC), dimensions (longitudinal, basal and mid-cavitary diameters), and tricuspid annular plane systolic excursion (TAPSE). Agreement between measures was evaluated. Sixty-three echocardiograms were analyzed. Intra- and inter-observer reliability was acceptable and similar between methods except that inter-observer reliability for the manual method was superior for TAPSE. Correlation between methods was high (r > 0.9, p < 0.001) for most of the measures. Correlation for FAC was r = 0.79, and for TAPSE the correlation was r = 0.61 (both p < 0.001). The percent relative difference between manual and semi-automated methods was less than 6% for most measures. End-systolic area and FAC had a relative difference of 10% and 11% respectively. The only measure with substantial bias between the manual and semi-automated methods was TAPSE which had a relative difference of 52%. EchoInsight® semi-automated software provides similar measures of right ventricular dimensions and FAC in patients with hypoplastic left heart compared to manual measures. Measures of TAPSE do not correlate well between manual and semi-automated methods. Further research is warranted on the use of semi-automated analyses in this patient population.
Collapse
Affiliation(s)
- Jamie Penk
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA.
- Lurie Children's Hospital, 225 E. Chicago Avenue, Box 21, Chicago, IL, 60611-2605, USA.
| | - Shireen Mukadam
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| | - S Javed Zaidi
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| | - Vivian Cui
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| | - Robert Metzger
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| | - David A Roberson
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| | - Yi Li
- Department of Pediatric Cardiology, Advocate Children's Hospital, 4440 W. 95th Street, Oak Lawn, Chicago, IL, 60453, USA
| |
Collapse
|
13
|
Goldberg CS, Hu C, Brosig C, Gaynor JW, Mahle WT, Miller T, Mussatto KA, Sananes R, Uzark K, Trachtenberg F, Pizarro C, Pemberton VL, Lewis AB, Li JS, Jacobs JP, Cnota J, Atz AM, Lai WW, Bellinger D, Newburger JW. Behavior and Quality of Life at 6 Years for Children With Hypoplastic Left Heart Syndrome. Pediatrics 2019; 144:e20191010. [PMID: 31628208 PMCID: PMC6856798 DOI: 10.1542/peds.2019-1010] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We measured behavioral, quality of life (QoL), and functional status outcomes for 6-year-old children with hypoplastic left heart syndrome enrolled in the Single Ventricle Reconstruction Trial. We sought to compare these outcomes with those in the normative population and to analyze risk factors for worse outcomes within the single-ventricle group. METHODS Parent-response instruments included the Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) (primary outcome), Behavior Assessment System for Children 2, Pediatric Quality of Life Inventory 4.0, and other measures of QoL and functional status. We compared subjects with those in the normative sample using 1-sample Wilcoxon rank tests and assessed outcome predictors using multivariable regression. RESULTS Of 325 eligible patients, 250 (77%) participated. Compared with population norms, participants had lower scores on the Vineland-II motor skills domain (90 ± 17 vs 100 ± 15; P < .001), with 11% scoring >2 SDs below the normative mean. On nearly all major domains, more study subjects (3.3%-19.7%) scored outside the normal range than anticipated for the general population. Independent risk factors for lower Vineland-II scores included perioperative extracorporeal membrane oxygenation, male sex, use of regional cerebral perfusion, catheterization after stage 2 operation, visual problems, seizure history, and more complications after 2 years (R 2 = 0.32). Independent predictors of worse Behavior Assessment System for Children 2 (R 2 = 0.07-0.20) and Pediatric Quality of Life Inventory 4.0 (R 2 = 0.17-0.25) domain scores also included sociodemographic factors and measures of morbidity and/or greater course complexity. CONCLUSIONS At 6 years, children with hypoplastic left heart syndrome had difficulty in areas of adaptive behavior, behavioral symptoms, QoL, and functional status. Principal risks for adverse outcomes include sociodemographic factors and measures of greater course complexity. However, models reveal less than one-third of outcome variance.
Collapse
Affiliation(s)
- Caren S Goldberg
- Department of Pediatrics, Medical School, University of Michigan and Michigan Medicine, Ann Arbor, Michigan;
| | - Chenwei Hu
- New England Research Institutes, Watertown, Massachusetts
| | - Cheryl Brosig
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - J William Gaynor
- Pediatric Cardiothoracic Surgery, School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - William T Mahle
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Thomas Miller
- Department of Pediatrics, and The University of Utah and Primary Children's Hospital, Salt Lake City, Utah
| | - Kathleen A Mussatto
- Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Renee Sananes
- Labatt Family Heart Center, Hospital for Sick Children, Toronto, Canada
| | - Karen Uzark
- Department of Pediatrics, Medical School, University of Michigan and Michigan Medicine, Ann Arbor, Michigan
| | | | - Christian Pizarro
- Department of Surgery, Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Victoria L Pemberton
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Alan B Lewis
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Jennifer S Li
- Department of Pediatrics, Duke University, Durham, North Carolina
- Department of Pediatrics, East Carolina University, Greenville, North Carolina
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | | | - James Cnota
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrew M Atz
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Wyman W Lai
- Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - David Bellinger
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; and
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; and
| |
Collapse
|
14
|
Osula D, Farris GR, Chatterjee A, Law MA, Cribbs MG. Intra-aortic Balloon Pump As a Bridge to Heart Transplant After Non-ST-Segment-Elevation Myocardial Infarction in Palliated Hypoplastic Left Heart Syndrome. Circ Heart Fail 2019; 12:e006130. [PMID: 31474118 DOI: 10.1161/circheartfailure.119.006130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Mark A Law
- Division of Pediatric Cardiology (M.A.L., M.G.C.)
| | - Marc G Cribbs
- Division of Cardiovascular Disease (G.R.F., A.C., M.G.C.)
- Division of Pediatric Cardiology (M.A.L., M.G.C.)
| |
Collapse
|
15
|
Laohachai K, Winlaw D, Sholler G, Veerappan S, Cole A, Ayer J. The Degree of Left Ventricular Hypoplasia Is Associated with Tricuspid Regurgitation Severity in Infants with Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2019; 40:1035-1040. [PMID: 31065756 DOI: 10.1007/s00246-019-02111-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/27/2019] [Indexed: 11/29/2022]
Abstract
Tricuspid valve regurgitation (TR) increases adverse outcomes in children with hypoplastic left heart syndrome (HLHS). Changes in tricuspid valve (TV) annulus and leaflet geometry have been described but the underlying causes for TR in HLHS remain uncertain. We aimed to examine the association between left ventricular (LV) size and TR in infants with HLHS as right ventricular (RV)-LV interactions may be important in TR development. Echocardiograms of 50 infants with HLHS were reviewed. LV size, RV function, TR grade, TV annulus z-score, and aortic arch obstruction were examined at birth and 1 year of age (or the latest study post-bidirectional Glenn anastomosis if the patient was < 1 year of age). 24/50 (48%) had severe LV hypoplasia and 26/50 (52%) had mild/moderate LV hypoplasia. At 1 year, 10/24 (42%) with severe LV hypoplasia had moderate/severe TR versus 0/26 in the mild/moderate LV hypoplasia group (p = 0.0002). TR progressed ( ≥ 1 grade) in 14/24(58%) with severe LV hypoplasia versus 5/26 (19%) with mild/moderate LV hypoplasia (p = 0.008). In this cohort, no association was found between the degree of TR and either RV function, TV annular z-score, or arch obstruction; or between the degree of LV hypoplasia and either RV function or TV annular z-score. In infants with HLHS, the severity and progression of TR is associated with the severity of LV hypoplasia. The mechanism for this association needs further exploration but suggests a role for RV-LV interactions in the development of TR.
Collapse
Affiliation(s)
- Karina Laohachai
- The Heart Centre for Children, The Children'S Hospital at Westmead, Locked Bag 4001, Sydney, NSW, 2145, Australia.
- The University of Sydney, Sydney, Australia.
| | - David Winlaw
- The Heart Centre for Children, The Children'S Hospital at Westmead, Locked Bag 4001, Sydney, NSW, 2145, Australia
- The University of Sydney, Sydney, Australia
| | - Gary Sholler
- The Heart Centre for Children, The Children'S Hospital at Westmead, Locked Bag 4001, Sydney, NSW, 2145, Australia
- The University of Sydney, Sydney, Australia
| | | | - Andrew Cole
- The Heart Centre for Children, The Children'S Hospital at Westmead, Locked Bag 4001, Sydney, NSW, 2145, Australia
| | - Julian Ayer
- The Heart Centre for Children, The Children'S Hospital at Westmead, Locked Bag 4001, Sydney, NSW, 2145, Australia
- The University of Sydney, Sydney, Australia
| |
Collapse
|
16
|
Belfort MA, Morris SA, Espinoza J, Shamshirsaz AA, Sanz Cortes M, Justino H, Ayres NA, Qureshi AM. Thulium laser-assisted atrial septal stent placement: first use in fetal hypoplastic left heart syndrome and intact atrial septum. Ultrasound Obstet Gynecol 2019; 53:417-418. [PMID: 30353586 DOI: 10.1002/uog.20161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/16/2018] [Indexed: 06/08/2023]
Affiliation(s)
- M A Belfort
- Departments of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - S A Morris
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - J Espinoza
- Departments of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - A A Shamshirsaz
- Departments of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - M Sanz Cortes
- Departments of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - H Justino
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - N A Ayres
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - A M Qureshi
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
17
|
Kailin JA, Dhillon GS, Maskatia SA, Cass DL, Shamshirsaz AA, Mehollin-Ray AR, Cassady CI, Ayres NA, Wang Y, Belfort MA, Olutoye OO, Ruano R. Fetal left-sided cardiac structural dimensions in left-sided congenital diaphragmatic hernia - association with severity and impact on postnatal outcomes. Prenat Diagn 2017; 37:502-509. [PMID: 28370263 DOI: 10.1002/pd.5045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 01/30/2017] [Accepted: 03/23/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Fetuses with congenital diaphragmatic hernia (CDH) demonstrate varying degrees of left heart hypoplasia. Our study assesses the relationship between fetal left-sided cardiac structural dimensions, lung size, percentage liver herniation, lung-to-head ratio, postnatal left-sided cardiac structural dimensions, and postnatal outcomes. METHODS We performed a retrospective cohort study of fetuses with left-sided CDH who had prenatal echocardiographic, ultrasound, and magnetic resonance imaging examinations at our institution between January 2007 and March 2015. Postnatal outcomes assessed include use of inhaled nitric oxide (iNO), use of extracorporeal membrane oxygenation, and death. RESULTS Fifty-two fetuses with isolated left-sided CDH were included. Multivariate logistic regression models indicated that smaller fetal aortic valve z-score was associated with postnatal use of iNO (p = 0.03). Fetal mitral valve z-score correlated with lung-to-head ratio (p = 0.04), postnatal mitral valve z-score correlated with percent liver herniation (p = 0.03), and postnatal left ventricular end-diastolic dimension z-score correlated with liver herniation <20% (p = 0.04). CONCLUSION We identified associations between smaller fetal left-sided cardiac structural dimensions and classic CDH indices. Smaller aortic valve z-score was associated with iNO use; however, left heart dimensions showed no association with extracorporeal membrane oxygenation or mortality. Further study into the impact of left-sided hypoplasia on outcomes in CDH is worthy of evaluation in a larger, prospective study. © 2017 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Joshua A Kailin
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Gurpreet S Dhillon
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Shiraz A Maskatia
- Section of Pediatric Cardiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Darrell L Cass
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alireza A Shamshirsaz
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Amy R Mehollin-Ray
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Christopher I Cassady
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Nancy A Ayres
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Yunfei Wang
- Department of Pediatric Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Michael A Belfort
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatric Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Rodrigo Ruano
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
18
|
Rodriguez RJ, Addonizio LJ, Lamour JM, Mital S, Mosca R, West LJ, Nova JC, Hsu DT. Pediatric Heart Transplantation across ABO Blood Type Barriers: A Case Study. Prog Transplant 2016; 15:161-5. [PMID: 16013465 DOI: 10.1177/152692480501500209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heart transplantation with ABO blood type–incompatible donors has historically been contraindicated because of the high risk of an immediate hyperacute humoral graft rejection. The immature neonatal immune system presents an immunologic window that allows for breaching the ABO barrier before the natural development of anti-ABO antibodies. Information from a small series of neonates has demonstrated similar survival rates and posttransplant outcomes compared to ABO-compatible transplantations. In the posttransplant period, particular attention is placed on the surveillance of graft-specific antibody production and monitoring for immunologic signs and symptoms of early graft vasculopathy. This article presents a case study of a neonate with congenital heart disease who underwent one of the first successful ABO-incompatible heart transplantations in the United States.
Collapse
|
19
|
Dayan JG, Peyvandi S, Moon-Grady AJ. Pulmonary Atresia With an Intact Ventricular Septum in the Setting of D-Transposition of the Great Arteries With a Hypoplastic Left Ventricle: Fetal Diagnosis. J Ultrasound Med 2015; 34:2313-2315. [PMID: 26507698 DOI: 10.7863/ultra.15.01074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Jonathan G Dayan
- Division of Pediatric Cardiology, University of California, San Francisco, California USA
| | - Shabnam Peyvandi
- Division of Pediatric Cardiology, University of California, San Francisco, California USA
| | - Anita J Moon-Grady
- Division of Pediatric Cardiology, University of California, San Francisco, California USA
| |
Collapse
|
20
|
Johnson JT, Sleeper LA, Chen S, Ohye RG, Gaies MG, Williams IA, Sachdeva R, Pruetz JD, Tatum GH, Thacker D, Brunetti MA, Frommelt MA, Jacobs JP, Kirsh JA, Lambert LM, Newburger JW, Pemberton VL, Zyblewski SC, Divanovic AA, Pinto NM. Associations Between Day of Admission and Day of Surgery on Outcome and Resource Utilization in Infants With Hypoplastic Left Heart Syndrome Who Underwent Stage I Palliation (from the Single Ventricle Reconstruction Trial). Am J Cardiol 2015; 116:1263-9. [PMID: 26303634 DOI: 10.1016/j.amjcard.2015.07.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/16/2015] [Accepted: 07/16/2015] [Indexed: 11/27/2022]
Abstract
Newborns with hypoplastic left heart syndrome and other single right ventricular variants require substantial health care resources. Weekend acute care has been associated with worse outcomes and increased resource use in other populations but has not been studied in patients with single ventricle. Subjects of the Single Ventricle Reconstruction trial were classified by whether they had a weekend admission and by day of the week of Norwood procedure. The primary outcome was hospital length of stay (LOS); secondary outcomes included transplant-free survival, intensive care unit (ICU) LOS, and days of mechanical ventilation. The Student's t test with log transformation and the Wilcoxon rank-sum test were used to analyze associations. Admission day was categorized for 533 of 549 subjects (13% weekend). The day of the Norwood was Thursday/Friday in 39%. There was no difference in median hospital LOS, transplant-free survival, ICU LOS, or days ventilated for weekend versus non-weekend admissions. Day of the Norwood procedure was not associated with a difference in hospital LOS, transplant-free survival, ICU LOS, or days ventilated. Prenatally diagnosed infants born on the weekend had lower mean birth weight, younger gestational age, and were more likely to be intubated but did not have a difference in measured outcomes. In conclusion, in this cohort of patients with single right ventricle, neither weekend admission nor end-of-the-week Norwood procedure was associated with increased use of hospital resources or poorer outcomes. We speculate that the complex postoperative course following the Norwood procedure outweighs any impact that day of admission or operation may have on these outcomes.
Collapse
Affiliation(s)
- Joyce T Johnson
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Lynn A Sleeper
- New England Research Institutes, Inc., Watertown, Massachusetts
| | - Shan Chen
- New England Research Institutes, Inc., Watertown, Massachusetts
| | - Richard G Ohye
- University of Michigan Health System, Ann Arbor, Michigan
| | | | | | - Ritu Sachdeva
- Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Jay D Pruetz
- Children's Hospital Los Angeles, Los Angeles, California
| | - Gregory H Tatum
- Duke Children's Hospital and Health Center, Durham, North Carolina
| | - Deepika Thacker
- Nemours/Alfred L. DuPont Hospital for Children, Wilmington, Delaware
| | | | | | | | | | - Linda M Lambert
- University of Utah at Primary Children's Hospital, Salt Lake City, Utah
| | | | | | | | | | - Nelangi M Pinto
- University of Utah at Primary Children's Hospital, Salt Lake City, Utah
| |
Collapse
|
21
|
Felesakis I, Kontomanolis E, Dalla P, Liberis A, Galazios G, Liberis V. Syndrome of hypoplastic left heart: a case report. CLIN EXP OBSTET GYN 2014; 41:100-101. [PMID: 24707698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 36-year-old woman, gravida 5, para 3, was referred to this outpatient clinic in the 18th week of gestation for monitoring of her pregnancy. A 22-week anomaly scan confirmed hypoplastic left heart syndrome (HLHS) but the parents declined any medical intervention. Here the authors present the management of a pregnancy and the expected quality of neonatal life.
Collapse
|
22
|
Abstract
Laparoscopic fundoplication and gastrostomy tube placement have grown in popularity within the pediatric population for treatment of gastroesophageal reflux disease and failure to thrive, respectively. One population that has an increased need for gastric surgery in infancy is patients with congenital heart defects, especially those with "single ventricle physiology." The most common defect included in this population is hypoplastic left heart syndrome (HLHS). Because of the abnormal physiology present in this condition, there are concerns with regard to the use of laparoscopic procedures for gastric surgery in patients treated with a three-staged reconstruction. We review the staged reconstruction of infants with HLHS, address safety concerns of interstage noncardiac procedures on this patient population, and review the current literature regarding outcomes of laparoscopic gastric surgery on patients with single ventricle physiology.
Collapse
Affiliation(s)
- Brian C H Gulack
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | |
Collapse
|
23
|
Stephenson EA. It is all in the timing: mechanical and electrical dyssynchrony in hypoplastic left heart syndrome. Heart Rhythm 2012; 9:2016-7. [PMID: 23085126 DOI: 10.1016/j.hrthm.2012.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Indexed: 11/29/2022]
|
24
|
Schulz S, Fröber R, Kraus C, Schneider U. Prenatal diagnosis of hypoplastic left heart syndrome associated with Noonan Syndrome and de novo RAF1 mutation. Prenat Diagn 2012; 32:1016-8. [PMID: 22821648 DOI: 10.1002/pd.3938] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 06/12/2012] [Accepted: 06/17/2012] [Indexed: 11/11/2022]
|
25
|
Gray RG, Minich LL, Weng HY, Heywood MC, Burch PT, Cowley CG. Effect of endovascular stenting of right ventricle to pulmonary artery conduit stenosis in infants with hypoplastic left heart syndrome on stage II outcomes. Am J Cardiol 2012; 110:118-23. [PMID: 22464211 DOI: 10.1016/j.amjcard.2012.02.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/26/2012] [Accepted: 02/26/2012] [Indexed: 11/28/2022]
Abstract
There is growing awareness that the Norwood procedure with the Sano modification is prone to early right ventricular to pulmonary artery (RV-PA) conduit stenosis resulting in systemic oxygen desaturation, increased interstage morbidity, and death. We report our experience with endovascular stent placement for conduit stenosis and compare the outcomes at stage II surgery between stented and nonstented infants. The medical records of all patients with hypoplastic left heart syndrome who received an RV-PA conduit at Norwood palliation from May 2005 to January 2010 were reviewed. The preoperative anatomy, demographics, operative variables, and outcomes pertaining to the Norwood and subsequent stage II surgeries were obtained and compared between stented and nonstented infants. The pre- and post-stent oxygen saturation, stenosis location, type and number of stents implanted, concomitant interventions, procedure-related complications, and reinterventions were collected. Of the 66 infants who underwent the Norwood procedure with RV-PA conduit modification, 16 (24%) received stents. The anatomy, demographics, and outcome variables after the Norwood procedure were similar between the stented and nonstented infants. The age at catheterization was 93 ± 48 days, and the weight was 4.9 ± 1.2 kg. The oxygen saturation increased from 66 ± 9% before intervention to 82 ± 6% immediately after stenting (p <0.0001). No interstage surgical shunt revisions were performed in either group. Age, weight, pre-stage II echocardiographic variables, oxygen saturation, and operative and outcome variables, including mortality, were similar between the 2 groups. In conclusion, endovascular stent placement for RV-PA conduit stenosis after the Norwood procedure leads to improved systemic oxygen levels and prevents early performance of stage II surgery without compromising stage II outcomes.
Collapse
|
26
|
Abstract
AIMS To assess perceptions of child behaviour and parenting stress among the parents of young children with hypoplastic left heart syndrome (HLHS) and other forms of functionally univentricular heart defects (UVH). METHODS As part of our prospective nation-wide neurodevelopmental follow-up study, the parents of 23 patients with HLHS, 14 with UVH and 46 healthy controls at the mean age of 18 months received the questionnaires Child Behavior Checklist and Parenting Stress Index. RESULTS The reported level of total parenting stress was significantly higher among the mothers (mean score 241 vs 205, p < 0.001) and fathers (235 vs 202, p = 0.003) of patients with HLHS compared with those of controls. The parents of patients with HLHS reported significantly more total (mean T score 52 vs 45, p = 0.005) and internalizing (51 vs 41, p < 0.001) behaviour problems than the controls, but among the syndrome scales, a significant difference was only found in somatic complaints. The parents of patients with UVH did not report more parenting stress or emotional problems than the controls. CONCLUSION Hypoplastic left heart syndrome, a severe congenital heart defect, increases parenting stress. The reported emotional maladjustment in affected children might in part be owing to somatic complaints.
Collapse
Affiliation(s)
- A Sarajuuri
- Children's Hospital, University of Helsinki, Finland.
| | | | | | | | | |
Collapse
|
27
|
Abstract
Tricuspid valve performance in the systemic circulation is known to have important implications for survival and functional status after univentricular palliation of hypoplastic left heart syndrome (HLHS). Moderate to severe tricuspid valve regurgitation is not an uncommon finding in patients with HLHS undergoing staged surgical reconstruction. It can result from either abnormal valve morphology or incomplete leaflet coaptation, or both. But first and foremost, any aortic arch re-obstruction must be excluded. Development of significant tricuspid regurgitation (TR) remains an obstacle in improving survival after the Norwood procedure and likely compromised functional health after the Fontan procedure. Thus, surgical intervention for minimizing tricuspid valve deterioration and significant TR seems pivotal to improving long-term outcomes for patients with HLHS. This article provides an overview of the etiology and mechanisms of development of significant TR, natural history, indications for surgical intervention, and focuses on timing, techniques, and clinical outcomes of tricuspid valve repair in the setting of single ventricle.
Collapse
Affiliation(s)
- Victor T Tsang
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom.
| | | |
Collapse
|
28
|
Abstract
Splenogonadal fusion is a rare congenital malformation where an abnormal union occurs between the spleen and gonad or mesonephric derivatives. Although it occurs in females it is much less prevalent than in males (male:female ratio, 16:1), but this may partly be because of the inaccessibility of the female gonads leading to under-diagnosis. To our knowledge this is the first case of splenogonadal fusion associated with sex reversal reported in the literature.
Collapse
Affiliation(s)
- Ruth Speare
- Department of Paediatric Surgery, Sheffield Children's Foundation Trust Hospital, Sheffield, UK
| | | | | | | |
Collapse
|
29
|
Maekawa Y, Sakamoto T, Umezu K, Ohashi N, Harada Y, Yasukochi S, Takigiku K, Takei K, Nakano Y, Inoue N, Otagiri T, Hashida Y. [Results of Norwood type operation for interrupted aortic arch complex; surgical decision making]. Kyobu Geka 2011; 64:785-791. [PMID: 21842666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Interrupted aortic arch (IAA) is associated with a multitude of lesions ranging from isolated ventricular septal defect to hypoplastic left ventricle or severe subaortic stenosis (SAS). Left ventricular outflow obstruction such as SAS continues to be an important factor for deciding the surgical procedure between univentricular and biventricular repairs. METHODS A retrospective study was conducted in 8 consecutive infants aged 14 to 117 days and operated on between 2004 and 2009. Seven patients had undergone bilateral pulmonary artery banding for pulmonary high flow regulation. All patients underwent Norwood-type operation (4 with systemic to pulmonary artery shunt, 3 with right ventricle to pulmonary artery shunt, and 1 with bidirectional Glenn shunt). RESULTS One patient died 2 months after surgery due to respiratory failure. The others were discharged in a good condition. One patient underwent Rastelli-type operation and biventricular circulation was achieved. The other 6 patients were all Fontan candidates. CONCLUSION Satisfactory initial palliation can be achieved by Norwood-type operation for IAA with severe SAS or hypoplastic left ventricular-aortic complex.
Collapse
Affiliation(s)
- Yoshiyuki Maekawa
- Division of Cardiovascular Surgery, Nagano Children's Hospital, Azumino, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Garey CL, Laituri CA, Aguayo P, O'Brien JE, Sharp RJ, St Peter SD, Ostlie DJ. Outcomes in children with hypoplastic left heart syndrome undergoing open fundoplication. J Pediatr Surg 2011; 46:859-62. [PMID: 21616241 DOI: 10.1016/j.jpedsurg.2011.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 02/11/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Some institutions recommend early fundoplication in patients with hypoplastic left heart syndrome (HLHS) with signs of gastroesophageal reflux disease because of the risk of reflux-related cardiac events. However, their cardiac physiology may impose high perioperative morbidity and mortality. Therefore, we reviewed our experience with fundoplication in this population to allow for assessment of the risk-benefit ratio. METHODS A retrospective review of patients with a diagnosis of HLHS who underwent a fundoplication from January 1990 to July 7, 2009, was performed. All patients underwent open fundoplication between first and second stages of cardiac repair. RESULTS Thirty-nine patients were identified. There were 3 intraoperative complications: hemodynamic instability (n = 2) and a pulmonary hypertensive crisis requiring extracorporeal membrane oxygenation and termination of the procedure (n = 1). There were 27 postoperative complications in 16 patients. There were 2 deaths (4%) within 30 days, and there were 9 deaths (23%) in patients between their first and second stage of cardiac repair during the study period. CONCLUSIONS Noncardiac surgical procedures in patients palliated for HLHS have a high morbidity and mortality. We recommend that routine fundoplication in this population should only be performed under prospective protocols until the relative risk of operation vs risk of reflux is delineated.
Collapse
Affiliation(s)
- Carissa L Garey
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | | | | | | | | | | | | |
Collapse
|
31
|
D'Alto M, Russo MG, Pacileo G, Paladini D, Romeo E, Sarubbi B, Cardaropoli D, Ricci C, Calabrò R. Left ventricular remodelling in outflow tract obstructive lesions during fetal life. J Cardiovasc Med (Hagerstown) 2009; 7:726-30. [PMID: 17001232 DOI: 10.2459/01.jcm.0000247318.27041.1e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Left ventricular (LV) remodelling in prenatally diagnosed LV outflow tract obstructive lesions such as aortic stenosis and aortic coarctation is important for prenatal counselling and postnatal management. The purpose of this study was to document the spectrum and the progression of different LV remodelling patterns and to identify prenatal markers of hypoplastic left heart syndrome (HLHS). METHODS We studied 29 fetuses with LV outflow tract obstruction: 13 with isolated aortic stenosis, 14 with isolated aortic coarctation and two with combined aortic stenosis and aortic coarctation. Echocardiographic evaluation was performed 4 and 8 weeks after the first observation and at birth. RESULTS None of the fetuses had HLHS (LV end-diastolic diameter z score higher than -2) at first prenatal echocardiography (24.5 + or - 3.6 weeks). Fetuses were divided into two groups: group A (n = 25) with a LV end-diastolic volume at birth > 20 ml/m(2); group B (n = 4) with a LV end-diastolic volume at birth < 20 ml/m(2) (LV hypoplasia). At first echocardiographic evaluation, the two groups showed a significantly different aorta to pulmonary ratio (0.44 + or - 0.08 vs. 0.86 + or - 0.14; P < 0.001); other LV echocardiographic features were not significantly different. The growth of the mitral (0.10 + or - 0.02 vs. 0.43 + or - 0.28 mm/week; P < 0.02) and aortic annulus (0.08 + or - 0.01 vs. 0.26 + or - 0.14 mm/week; P < 0.05) was significantly slower in group B. CONCLUSIONS Our data suggest that LV outflow tract obstruction can progressively evolve in HLHS during pregnancy. A smaller aorta to pulmonary ratio was the only significant difference at initial echocardiographic evaluation in the two groups. Moreover, serial echocardiographic examinations are necessary to recognize fetuses at risk for HLHS caused by a subnormal growth rate of the mitral and aortic annulus.
Collapse
Affiliation(s)
- Michele D'Alto
- Chair of Cardiology, Second University of Naples, V. Monaldi Hospital, Naples, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Burns L, Maul EC. Benign pneumatosis intestinalis in a child with cavopulmonary shunt and immune thrombocytopenic purpura. J Hosp Med 2009; 4:E41-2. [PMID: 19753588 DOI: 10.1002/jhm.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We present the case of a nine-year-old boy with hypoplastic left heart syndrome and immune thrombocytopenic purpura who subsequently developed pneumatosis intestinails with a benign clinical examination. While benign pneumatosis intestinails is a well-known clinical entity, the alarming radiographic findings set off a cascade of clinical angst among many providers. This case reminds physicians to correlate the ancillary study results with the patient's clinical presentation and stability.
Collapse
Affiliation(s)
- Lindsay Burns
- Pediatrics Residency Program, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | | |
Collapse
|
33
|
Do TB, Chu JM, Berdjis F, Anas NG. Fontan patient with plastic bronchitis treated successfully using aerosolized tissue plasminogen activator: a case report and review of the literature. Pediatr Cardiol 2009; 30:352-5. [PMID: 19005718 DOI: 10.1007/s00246-008-9312-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 09/12/2008] [Indexed: 11/27/2022]
Abstract
Plastic bronchitis is an uncommon condition characterized by the production of large pale bronchial casts that obstruct the tracheobronchial tree. The cellular content, cohesiveness, and often rubber-like consistency distinguish bronchial casts from the usual mucus plugs found with such disease states as asthma. Plastic bronchitis can be found secondary to many conditions, and a simplified classification scheme organizes it into two groups: an inflammatory type consisting of casts with an eosinophilic inflammatory infiltrate and an acellular type with a predominance of fibrin distinguished by its relative lack of cellular infiltrate, its mucin predominance, and its appearance only in children with congenital cyanotic heart disease. This report describes a 5-year-old girl who experienced plastic bronchitis 3 months after a Fontan procedure for hypoplastic left heart syndrome that was treated successfully with aerosolized tissue plasminogen activator.
Collapse
Affiliation(s)
- Thomas B Do
- Children's Hospital of Orange County, Orange, CA 92868, USA.
| | | | | | | |
Collapse
|
34
|
Jurko A, Minarik M, Misovicova N, Jurko A. Moebius syndrome associated with hypoplastic left heart syndrome. BRATISL MED J 2009; 110:361-362. [PMID: 19634579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The authors present a newborn infant from the second pregnancy whose mother experienced influenza A infection in the first trimester. The birth was at term without complications, but 11 hours later, cyanosis and tachypnoe developed. The final diagnosis was hypoplastic left heart syndrome with simultaneous Moebius Syndrome. In conclusion the authors indicate that echocardiography is of great importance in the diagnosis of this complex heart disease as it helps to analyze in detail the options in the diagnosis of rare Moebius Syndrome (Fig. 2, Ref. 8).
Collapse
Affiliation(s)
- A Jurko
- Pediatric Cardiology Clinic, Martin, Slovakia.
| | | | | | | |
Collapse
|
35
|
Irving CA, Chaudhari MP. Fatal presentation of congenital isolated left ventricular apical hypoplasia. Eur J Cardiothorac Surg 2008; 35:368-9. [PMID: 19070501 DOI: 10.1016/j.ejcts.2008.10.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 10/16/2008] [Accepted: 10/29/2008] [Indexed: 11/20/2022] Open
Abstract
Congenital isolated left ventricular apical hypoplasia has recently been recognised as a discrete clinical entity with well-defined diagnostic criteria on cardiac magnetic resonance imaging. This spectrum has been described in four previous cases, three of which presented with relatively mild symptoms and one with pulmonary oedema. All of these patients responded to standard medical management. We describe a sudden and fatal presentation of this anomaly in a previously well 19-year-old male, confirming the fact that this is not a benign condition but a spectrum with the potential for significant complications.
Collapse
Affiliation(s)
- Claire A Irving
- Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, England, UK
| | | |
Collapse
|
36
|
Abstract
Children with hypoplastic left heart syndrome (HLHS) have an increased prevalence of central nervous system (CNS) abnormalities. The extent to which this problem is due to CNS maldevelopment, prenatal ischemia, postnatal chronic cyanosis and/or multiple exposures to cardiopulmonary bypass is unknown. To better understand the etiology of CNS abnormalities in HLHS, we evaluated 68 neonates with HLHS; in 28 cases, both fetal ultrasound and echocardiogram data were available to assess head size, head growth and aortic valve anatomy (atresia or stenosis). In addition, we evaluated neuropathology in 11 electively aborted HLHS fetuses. The mean head circumference percentile in HLHS neonates was significantly smaller than HLHS fetuses (22 +/- 2% versus 40 +/- 4%, p < 0.001). A significant decrease in head growth, defined as a 50% reduction in head circumference percentile, was observed in half (14/28) of HLHS fetuses and nearly a quarter (6/28) were already growth restricted (<or=10%) at the time of initial evaluation. Brains from HLHS fetuses demonstrated chronic diffuse white matter injury of varying severity. These patterns of prenatal head growth and brain histopathology identify a spectrum of abnormal CNS development and/or injury in HLHS fetuses.
Collapse
Affiliation(s)
- Robert B Hinton
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Davis D, Davis S, Cotman K, Worley S, Londrico D, Kenny D, Harrison AM. Feeding difficulties and growth delay in children with hypoplastic left heart syndrome versus d-transposition of the great arteries. Pediatr Cardiol 2008; 29:328-33. [PMID: 17687586 DOI: 10.1007/s00246-007-9027-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 06/12/2007] [Indexed: 10/23/2022]
Abstract
The objective of this study was to identify the incidence of feeding difficulties in infants with hypoplastic left heart syndrome (HLHS) and d-transposition of the great arteries (d-TGA). Congenital heart disease is a risk factor for growth failure. The etiologies include poor caloric intake, inability to utilize calories effectively, and increased metabolic demands. The goals of our study were to (1) identify feeding difficulties in infants with HLHS and d-TGA and (2) assess their growth in the first year of life. We performed a chart review of 27 consecutive infants with HLHS and 26 with d-TGA. Descriptive statistics were generated for demographic and clinical variables within each group and are presented as means +/- standard deviations. HLHS and d-TGA groups were compared on time to achieving nutritional goals using the log rank test, on complication rate using the chi-square test, and on weight using the t-test. A significance level of 0.05 was used for all tests. Birth weight was similar for both the HLHS and d-TGA groups (3.19 +/- 0.69 vs 3.35 +/- 0.65 kg, respectively; p = 0.38). Infants with HLHS weighed less than those with d-TGA at l month (3.29 +/- 0.58 vs 3.70 +/- 0.60 kg, respectively; p = 0.021), 6 months (6.27 +/- 1.06 vs 7.31 +/- 1.02 kg, p = 0.003), and 12 months of age (8.40 +/- 1.11 vs 9.49 +/- 1.01 kg, p = 0.006). Time to achieving full caloric intake (at least 100 kcal/kg/day) for the HLHS group (24 +/- 11.9 days) was significantly longer than for the d-TGA group (12.0 +/- 11.2 days, p < 0.001). In addition, infants with HLHS had a higher incidence of feeding-related complications that those with d-TGA (48 vs 4%, respectively; p = 0.001). Compared to the d-TGA group, infants with HLHS weighed less at follow-up, took longer to reach nutritional goals, and had a much higher incidence of feeding-related complications.
Collapse
Affiliation(s)
- D Davis
- Division of Pediatrics, The Children's Hospital, Cleveland Clinic, 9500 Euclid Avenue, S20, Cleveland, OH 44195, USA.
| | | | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Robert MLP, Lopez T, Crolla J, Huang S, Owen C, Burvill-Holmes L, Stumper O, Turnpenny PD. Alagille syndrome with deletion 20p12.2-p12.3 and hypoplastic left heart. Clin Dysmorphol 2007; 16:241-6. [PMID: 17786115 DOI: 10.1097/mcd.0b013e3282358d21] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a male patient born at 37-weeks gestation, weighing 1.885 kg (<0.4th centile). Shortly after birth, he was diagnosed with hypoplastic left heart syndrome for which he underwent a Norwood procedure. Subsequently, he developed problems with failure to thrive and developmental delay. At the age of 4 years his delay in growth and development led to further investigations, which revealed a small de-novo interstitial deletion of chromosome 20p12.2. JAGGED1 haploinsufficiency was confirmed by fluorescence in situ hybridization. Array-comparative genomic hybridization analysis confirmed and quantified an approximate 5.4 Mb interstitial deletion involving the chromosomal region 20p12.2-p12.3. This precise interstitial deletion has not been previously reported. Further clinical evaluation revealed posterior embryotoxon and butterfly vertebrae. He has normal liver function tests, facial features consistent with Alagille syndrome, and mild learning difficulties. To our knowledge this is the first report of Alagille syndrome associated with hypoplastic left heart syndrome.
Collapse
|
40
|
|
41
|
Scheurer MA, Hill EG, Vasuki N, Maurer S, Graham EM, Bandisode V, Shirali GS, Atz AM, Bradley SM. Survival after bidirectional cavopulmonary anastomosis: Analysis of preoperative risk factors. J Thorac Cardiovasc Surg 2007; 134:82-9, 89.e1-2. [PMID: 17599490 DOI: 10.1016/j.jtcvs.2007.02.017] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 01/12/2007] [Accepted: 02/05/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Prognostic factors for survival after bidirectional cavopulmonary anastomosis for functionally single ventricle are not well defined. We analyzed preoperative hemodynamic and echocardiographic data to determine risk factors for death or transplantation at least 1 year after bidirectional cavopulmonary anastomosis. METHODS Data for all patients who underwent bidirectional cavopulmonary anastomosis before 5 years of age at our institution from September 1995 through June 2005 were analyzed. Available preoperative echocardiograms and catheterizations were reviewed. Survivors were compared with those who died or underwent transplantation. Bivariable associations between demographic and clinical risk factors and survival status (alive without transplantation vs dead or transplanted) were assessed with Wilcoxon rank sum test and chi2 or Fisher exact tests. Survival functions were constructed with Kaplan-Meier estimates, and event times compared between subgroups with log-rank tests. Cox proportional hazard modeling was used for multivariable modeling of risk of death or transplantation. RESULTS One hundred sixty-seven patients underwent bidirectional cavopulmonary anastomosis with hemi-Fontan (n = 62) or bidirectional Glenn (n = 105) operations. Three patients died before discharge, 11 died later, and 1 has undergone transplantation. Freedom from death or transplantation after bidirectional cavopulmonary anastomosis was 96% at 1 year and 89% at 5 years. Multivariable analysis of preoperative variables showed atrioventricular valve regurgitation to be an independent risk factor for death or transplantation (hazard ratio 2.8, 95% confidence interval 1.1-7.1, P = .02). CONCLUSION Although survival after bidirectional cavopulmonary anastomosis is high, preoperative atrioventricular valve regurgitation is an important risk factor for death or transplantation.
Collapse
Affiliation(s)
- Mark A Scheurer
- Department of Cardiology, Children's Hospital Boston, Boston, Mass 02115, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Taborosi B, Tödt-Pingel I, Kayser G, Dittrich S. A rare case of aortic coarctation and ventricular septal defect combined with alveolar capillary dysplasia. Pediatr Cardiol 2007; 28:319-23. [PMID: 17530317 DOI: 10.1007/s00246-007-0049-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 03/17/2007] [Indexed: 11/29/2022]
Abstract
We report a rare case of alveolar capillary dysplasia (ACD) associated with severe aortic coarctation, hypoplastic aortic arch, and mild hypoplasia of the left ventricle. After successful coarctation repair, pulmonary hypertension persisted, and despite only minor anomalies on the x-ray, chest computed tomography (CT) revealed the presence of primary lung disease. Review of the literature suggests that ACD may be associated with left heart obstructions. Chest CT is applicable to diagnose ACD precociously.
Collapse
Affiliation(s)
- B Taborosi
- Department of Congenital Heart Disease, University of Freiburg, Mathildenstrasse 1, D-79106, Freiburg, Germany
| | | | | | | |
Collapse
|
43
|
Abstract
PURPOSE OF REVIEW Advancements in surgical technique and perioperative care have significantly improved the survival of infants born with hypoplastic left heart syndrome. A recent modification to the Norwood procedure is being adopted by many centers to improve postoperative hemodynamic stability and survival to stage II palliation. The late effects of this modification, however, are speculated and have not been investigated. RECENT FINDINGS Center-specific improved short-term outcomes have been reported in a few small, nonrandomized studies of a new approach to the Norwood procedure, which utilizes a right ventricle to pulmonary artery shunt or Sano modification to provide pulmonary blood flow rather than the standard modified Blalock-Taussig shunt. SUMMARY The classic Norwood procedure and Sano modification each have specific advantages and disadvantages in both the short and long term. Data comparing the two techniques are nonrandomized, contradictory, and utilize historical controls. The optimal shunt to improve survival to the second-stage palliation is unknown. A multicenter randomized clinical trial comparing the Sano with the modified Blalock-Taussig shunt in hypoplastic left heart syndrome or variants is currently in progress and should hopefully provide future guidelines for shunt selection based on clinical presentation.
Collapse
Affiliation(s)
- Brian L Reemtsen
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | | | | |
Collapse
|
44
|
Chu MWA, Sharma K, Tchervenkov CI, Jutras LF, Lavoie J, Shemie SD, Laliberte E, Calaritis C, Cecere R. Berlin Heart Ventricular Assist Device in a Child With Hypoplastic Left Heart Syndrome. Ann Thorac Surg 2007; 83:1179-81. [PMID: 17307489 DOI: 10.1016/j.athoracsur.2006.08.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 08/05/2006] [Accepted: 08/09/2006] [Indexed: 11/24/2022]
Abstract
We report the implantation of a Berlin Heart ventricular assist device (VAD) in a 4-year-old boy with hypoplastic left heart syndrome previously palliated with Norwood and Glenn operations, who presented with progressive ventricular failure and hypoxemia. Insertion of a 30-mL pneumatic pediatric pump with cannulation of the systemic right ventricle and aorta had a salutary effect on cardiac output, improving oxygen saturations. While awaiting heart transplantation, multiple thromboembolic complications developed and he died, despite therapeutic heparinization and aspirin therapy. Important lessons learned about VAD support in Glenn physiology, anticoagulation, and complications of the Berlin Heart are discussed.
Collapse
Affiliation(s)
- Michael W A Chu
- Division of Pediatric Cardiovascular Surgery, Montreal Children's Hospital, Montréal, Québec, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Bove EL, Ohye RG, Devaney EJ, Hirsch J. Tricuspid valve repair for hypoplastic left heart syndrome and the failing right ventricle. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:101-4. [PMID: 17434000 DOI: 10.1053/j.pcsu.2007.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Tricuspid valve regurgitation in patients with hypoplastic left heart syndrome is a cause of significant morbidity and mortality. Due to the multifactorial nature of its etiology, repair of the tricuspid valve may not always address the underlying problem and fail to improve late outcome. The role of tricuspid valve repair in this condition was examined in a series of patients with severe regurgitation following a Norwood procedure. The influence of surgical technique and right ventricular function were assessed in relation to late survival and tricuspid valve function. Tricuspid valve repair was successfully performed in the majority of patients and contributed to improved late outcomes. However, patients with an initially successful repair but significant right ventricular dysfunction tended to do poorly and the function of the valve often continued to deteriorate. Those with preserved ventricular function, even with continued tricuspid regurgitation, fared much better and achieved good results with additional attempts at repair.
Collapse
Affiliation(s)
- Edward L Bove
- Division of Pediatric Cardiovascular Surgery, Section of Cardiac Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA.
| | | | | | | |
Collapse
|
46
|
Brosig CL, Mussatto KA, Kuhn EM, Tweddell JS. Neurodevelopmental outcome in preschool survivors of complex congenital heart disease: implications for clinical practice. J Pediatr Health Care 2007; 21:3-12. [PMID: 17198894 DOI: 10.1016/j.pedhc.2006.03.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 03/22/2006] [Accepted: 03/23/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this study was to describe the neurodevelopmental outcome of preschool survivors of Hypoplastic Left Heart Syndrome (HLHS) and Transposition of the Great Arteries (TGA) in the modern surgical era. METHODS A cross-sectional design was used to evaluate 26 children (13 HLHS, 13 TGA), ages 3.5 to 6 years, at a Midwestern children's hospital. Measures included McCarthy Scales of Children's Abilities, Woodcock Johnson III Tests of Achievement, Developmental Test of Visual-Motor Integration, Receptive One-Word Vocabulary Test, Expressive One-Word Vocabulary Test, and Child Behavior Checklist. RESULTS Although intelligence quotient scores fell within the average range for both groups (TGA=110.5 vs. HLHS=97), the difference between groups was clinically meaningful (effect size= .79). The HLHS group showed more problems than did the TGA group with visual-motor skills, expressive language, attention, and externalizing behavior. DISCUSSION Results suggest that even in the modern surgical era, regular developmental screening for these patients is critical. Pediatric nurse practitioners play an important role in educating parents about the potential developmental risks to these children.
Collapse
Affiliation(s)
- Cheryl L Brosig
- Medical College of Wisconsin, Department of Pediatrics, Milwaukee,Wisconsin, USA
| | | | | | | |
Collapse
|
47
|
Villa E, Brancaccio G, Carotti A, Francalanci P, Di Donato RM. Circumflex coronary artery from right pulmonary artery in hypoplastic left heart syndrome. Ann Thorac Surg 2006; 80:1919-20. [PMID: 16242487 DOI: 10.1016/j.athoracsur.2004.06.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Revised: 06/01/2004] [Accepted: 06/07/2004] [Indexed: 11/26/2022]
Abstract
We report the case of a newborn with the very rare association of hypoplastic left heart syndrome and aberrant origin of the circumflex coronary artery from the right pulmonary artery. This condition can jeopardize the result of the Norwood palliation.
Collapse
Affiliation(s)
- Emmanuel Villa
- Department of Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
| | | | | | | | | |
Collapse
|
48
|
Abstract
The outlook for patients with hypoplastic left heart syndrome has dramatically improved over the past two decades. Universally fatal only 25 years ago, since that time outcomes for staged palliation have shown consistent improvement. Recent reports show that eight to nine patients from every ten can now leave the hospital after the Norwood procedure.1Attrition following the Norwood procedure, nonetheless, remains significant, with from five to fifteen percent of patients dying between the first and second stages of the Norwood sequence.1–4Only three-quarters of the patients undergoing surgery for hypoplastic left heart syndrome survive after five years, even at the centres reporting the best outcomes for the Norwood procedure.1,5In addition to the deaths, some patients are unable to progress through the three stages of reconstruction, and may require cardiac transplantation, or have no options for further therapy. There are many causes for these mortalities and morbidities following the Norwood procedure, including elevated pulmonary vascular resistance, cardiac arrhythmias, coronary arterial insufficiency, right ventricular failure, right ventricular volume overload due to shunt-dependent physiology, and tricuspid valvar regurgitation. Many of these factors are interrelated, and may form feedback loops, which serve to propagate their adverse effects on patients with hypoplastic left heart syndrome.
Collapse
Affiliation(s)
- Richard G Ohye
- Division of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
| | | | | | | | | | | |
Collapse
|
49
|
Kelleher DK, Laussen P, Teixeira-Pinto A, Duggan C. Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure. Nutrition 2006; 22:237-44. [PMID: 16500550 DOI: 10.1016/j.nut.2005.06.008] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Accepted: 06/08/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND Protein-energy malnutrition is common among infants with congenital heart disease. We hypothesized that infants with hypoplastic left heart syndrome (HLHS) are at risk for malnutrition. OBJECTIVE To determine the prevalence of and risk factors for malnutrition in infants undergoing palliative surgery for HLHS. METHODS Retrospective chart review of 50 infants with HLHS who underwent both stage 1 Norwood and bidirectional Glenn (BDG) procedures over 4.5 y. RESULTS After a median hospital stay of 21 d, median discharge weight was 3.4 kg, unchanged from admission. Adjusting for weight on admission, children with longer length of hospital stay, longer intensive care unit stay, shorter duration of parental nutrition therapy, and higher diuretic dosage at discharge had a lower weight-for-age Z score at discharge (R2=0.85). On admission for BDG, median weight-for-age Z score was -2.0. After adjusting for weight on discharge from the initial hospitalization, children with fewer calories/ounce of their enteral nutrition at discharge, worse right ventricular function, more frequent readmissions, and higher oxygen saturation at discharge had a lower weight-for-age Z score at BDG (R2=0.49). CONCLUSIONS Malnutrition is common in infants with HLHS after stage 1 palliation. Variables associated with more complex postoperative course and imbalance between systemic and pulmonary blood flow were all associated with poorer nutritional status. When adjusting for these factors, the use of parenteral nutrition and high calorie enteral feeds were associated with improved nutritional status. Aggressive parenteral and enteral nutritional therapy might help reduce the prevalence of growth faltering in infants who have HLHS.
Collapse
Affiliation(s)
- Deanne K Kelleher
- Division of GI/Nutrition, Children's Hospital Boston, Boston, Massachusetts, USA
| | | | | | | |
Collapse
|
50
|
Gossett JG, Rocchini AP, Lloyd TR, Graziano JN. Catheter-based decompression of the left atrium in patients with hypoplastic left heart syndrome and restrictive atrial septum is safe and effective. Catheter Cardiovasc Interv 2006; 67:619-24. [PMID: 16547929 DOI: 10.1002/ccd.20630] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infants with hypoplastic left heart syndrome (HLHS) and restrictive or intact atrial septum (rAS) present with cyanosis, pulmonary edema, and are critically ill. A previous report from our institution on emergent Norwood for HLHS with rAS showed 10% survival. We hypothesized that transcatheter left atrial (LA) decompression in HLHS with rAS would safely and effectively relieve LA hypertension, improve oxygenation, and improve Norwood survival. Between 1996 and 2004, 30 patients with HLHS and rAS underwent cardiac catheterization for pre-Norwood intervention. Twenty-eight atrial septostomies were performed: 23 static balloon dilations, 4 Rashkind septostomies, and 1 intra-atrial stent. Two procedures were aborted due to perforation (n = 1) or inability to enter the LA (n = 1). Eight total patients required surgical septectomy, for a failure rate of 27%. There were no catheter-related mortalities, although two patients died within 36 hr of the procedure after surgical septectomy. Major complications occurred in three patients (10%)--atrial perforations requiring intervention. Mean atrial septal defect gradient fell from 16.7 +/- 4.9 to 6.3 +/- 3.4 mm Hg (P < 0.001; n = 18). Mean LA pressure dropped from 21.8 +/- 5.5 to 13.1 +/- 6.5 mm Hg (P < 0.001; n = 16). Mean PaO(2) rose from 29.5 +/- 9.1 to 36.5 +/- 5.1 torr (P < 0.001; n = 23). Seventeen of 30 patients (57%) survived to discharge from Norwood. Thirteen have undergone hemi-Fontan and nine Fontan. Sixteen of 22 successful decompressions (73%) survived to discharge. Transcatheter decompression of the LA for patients with HLHS and rAS can be performed safely, reduces the transatrial gradient, and improves oxygenation. Catheter intervention improves survival compared to historical controls undergoing emergent Norwood.
Collapse
MESH Headings
- Cardiac Catheterization
- Decompression, Surgical/methods
- Female
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/mortality
- Heart Septal Defects, Atrial/surgery
- Humans
- Hypoplastic Left Heart Syndrome/complications
- Hypoplastic Left Heart Syndrome/mortality
- Hypoplastic Left Heart Syndrome/surgery
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/surgery
- Male
- Retrospective Studies
- Survival Rate
- Treatment Outcome
- Ventricular Pressure
Collapse
Affiliation(s)
- Jeffrey G Gossett
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Health System, Ann Arbor, USA
| | | | | | | |
Collapse
|