Hypoplastic left heart syndrome: Hemodynamic and angiographic assessment after initial reconstructive surgery and relevance to modified fontan procedure

Anthony C. Chang, Paul E. Farrell, Kenneth A Murdison, Jeanne M. Baffa, Gerald Barber, William I. Norwood, John D. Murphy

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

After undergoing initial reconstructive surgery for hypoplastic left heart syndrome performed between August 1985 and March 1989, 59 patients (age range 3 to 27 months, mean 13.8 ± 4.5) underwent elective cardiac catheterization in anticipation of a modified Fontan procedure. Five important hemodynamic and anatomic features considered to be components or successful reconstructive surgery were specifically addressed. 1) Interatrial communication: Only two patients had a measured pressure difference of >4 mm Hg across the atrial septum. 2) Tricuspid valve function: Angiography demonstrated significant tricuspid valve regurgitation in only five patients (moderate in two and severe in three). 3) Aortic arch: Pressure tracings from the right ventricle to the descending aorta revealed a gradient >25 mm Hg in only two patients. 4) Pulmonary vasculatare: Ten patients had a calculated pulmonary vascular resistance >4 U · m2; 51 (86%) of the 59 patients had no evidence of distortion (stenosis or hypoplasia) of either the left or the right pulmonary artery. 5) Right ventricular function: Five patients had an end-diastolic pressure in the right ventricle >12 mm Hg and two patients had qualitative assessment of decreased ventricular function. Comparison of catheterization data between survivors and nonsurvivors of the subsequent modified Fontan procedure showed that only significant tricuspid regurgitation is a possible predictor of poor outcome. After first stage reconstructive surgery for hypoplastic left heart syndrome, most survivors have favorable anatomy and hemodynamics at follow-up cardiac catheterization for a subsequent Fontan procedure.

Original languageEnglish (US)
Pages (from-to)1143-1149
Number of pages7
JournalJournal of the American College of Cardiology
Volume17
Issue number5
DOIs
StatePublished - Jan 1 1991
Externally publishedYes

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Reconstructive Surgical Procedures
Hypoplastic Left Heart Syndrome
Fontan Procedure
Hemodynamics
Tricuspid Valve Insufficiency
Cardiac Catheterization
Thoracic Aorta
Heart Ventricles
Survivors
Atrial Septum
Right Ventricular Function
Tricuspid Valve
Ventricular Function
Catheterization
Vascular Resistance
Pulmonary Artery
Anatomy
Angiography
Arterial Pressure
Pathologic Constriction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Hypoplastic left heart syndrome : Hemodynamic and angiographic assessment after initial reconstructive surgery and relevance to modified fontan procedure. / Chang, Anthony C.; Farrell, Paul E.; Murdison, Kenneth A; Baffa, Jeanne M.; Barber, Gerald; Norwood, William I.; Murphy, John D.

In: Journal of the American College of Cardiology, Vol. 17, No. 5, 01.01.1991, p. 1143-1149.

Research output: Contribution to journalArticle

Chang, Anthony C. ; Farrell, Paul E. ; Murdison, Kenneth A ; Baffa, Jeanne M. ; Barber, Gerald ; Norwood, William I. ; Murphy, John D. / Hypoplastic left heart syndrome : Hemodynamic and angiographic assessment after initial reconstructive surgery and relevance to modified fontan procedure. In: Journal of the American College of Cardiology. 1991 ; Vol. 17, No. 5. pp. 1143-1149.
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