Fate of ventricular and valve performance following early bidirectional glenn procedure after norwood operation controlled for hypoplastic left heart syndome anatomic subtype

Anastasios Charalanpos Polimenakos, John W. Bokowski, Hani S. Ghawi, Chawki F. El-Zein, Michel N. Ilbawi

Research output: Contribution to journalArticle

Abstract

The Norwood operation (NO) with a right ventricle (RV)-to-pulmonary artery (PA) shunt (NRVPA) is reportedly associated with early hemodynamic advantage. Shunt strategy has been implicated in ventricular function. Outcomes after NRVPA compared with classic procedure as part of a strategy involving early bidirectional Glenn (BDG) procedure were analyzed with reference to RV, tricuspid, and neoaortic valve performance. Between January 2005 and December 2010, 128 neonates with hypoplastic left heart syndrome (HLHS) underwent NO. Controlled for aortic/mitral stenosis (AS-MS) subtype, 28 patients underwent NRVPA (group A), and 26 patients had classic procedure (group B). The patients with a non-HLHS single-ventricle anatomy and those who had undergone a hybrid approach for HLHS were excluded from the study. The mean age at NO was 6.8 ± 3.5 days in group A and 6.9 ± 3.6 days in group B. Transthoracic echocardiographic evaluation (TTE) after NO (TTE-1) at the midinterval between NO and BDG (TTE-2), before BDG (TTE-3), before Fontan (TTE-4), and at the last follow-up evaluation (TTE-5) was undertaken. Cardiac catheterization was used to assess hemodynamic parameters before the Glenn and Fontan procedures. The operative, interstage, and pre-Fontan survival rates for AS-MS after NO were respectively 88.1 % (90.3 % in group A vs. 84.7 % in group B; p = 0.08), 82.5 % (82.7 % in group A vs. 81.8 % in group B; p = 0.9), and 80.7 % (79.5 % in group A vs. 81.8 % in group B; p = 0.9). The median follow-up period was 39.6 months (interquartile range 2.7-4.9 months). The RV global function, mid- and longitudinal indexed dimensions, fractionated area change before BDG (TTE-1, TTE-2, TTE-3) and after BDG (TTE-4, TTE-5), and right ventricular end-diastolic pressure did not differ statistically between the groups (p > 0.05). No statistically significant difference in tricuspid or neoaortic intervention was found between the groups (p > 0.05). Controlled for the AS-MS HLHS subtype, shunt strategy showed no midterm survival or hemodynamic (ventricular or valve) impact. At midterm, the follow-up need for neoaortic or tricuspid valve surgical intervention was not affected by shunt selection. The structural ventricular adaptation after reversal of shunt physiology was irrespective of shunt strategy.

Original languageEnglish (US)
Pages (from-to)332-343
Number of pages12
JournalPediatric Cardiology
Volume35
Issue number2
DOIs
StatePublished - Feb 1 2014
Externally publishedYes

Fingerprint

Norwood Procedures
Fontan Procedure
Hypoplastic Left Heart Syndrome
Heart Ventricles
Tricuspid Valve
Hemodynamics
Ventricular Function
Mitral Valve Stenosis
Aortic Valve Stenosis
Cardiac Catheterization
Pulmonary Artery

Keywords

  • Hypoplastic left heart syndrome
  • Shunt
  • Valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Fate of ventricular and valve performance following early bidirectional glenn procedure after norwood operation controlled for hypoplastic left heart syndome anatomic subtype. / Polimenakos, Anastasios Charalanpos; Bokowski, John W.; Ghawi, Hani S.; El-Zein, Chawki F.; Ilbawi, Michel N.

In: Pediatric Cardiology, Vol. 35, No. 2, 01.02.2014, p. 332-343.

Research output: Contribution to journalArticle

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AU - El-Zein, Chawki F.

AU - Ilbawi, Michel N.

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