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RIGHT VENTRICULAR REMODELLING IN HYPOPLASTIC LEFT HEART SYNDROME: IMPACT OF THE NORWOOD AND HYBRID PROCEDURES
620 JACC March 21, 2017 Volume 69, Issue 11
Congenital Heart Disease RIGHT VENTRICULAR REMODELLING IN HYPOPLASTIC LEFT HEART SYNDROME: IMPACT OF THE NORWOOD AND HYBRID PROCEDURES Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Congenital Heart Disease: Innovations in Single Ventricle Heart Disease Abstract Category: 10. Congenital Heart Disease: Pediatric Presentation Number: 1182-010 Authors: Kandice Mah, Jesus Serrano Lomelin, Luke Eckersley, Lily Lin, Timothy Colen, Edythe Tham, Harald Becher, Luc Mertens, Nee Scze Khoo, Stollery Children’s Hospital, Edmonton, Canada, Sickkids, Toronto, Canada
Background: Right ventricular (RV) remodeling in hypoplastic left heart syndrome (HLHS) begins prenatally and continues through staged palliations. The impact of cardiopulmonary bypass (CPB) timing on HLHS RV remodeling, early in Norwood-Sano vs. later in Hybrid palliation, is unclear. Methods: Echocardiograms of HLHS patients undergoing stage-1 Norwood or Hybrid (Jan 2007 - Dec 2011) were longitudinally analyzed at Pre & Post-stage 1, Pre & Post-Glenn, and Pre-Fontan. We assessed RV fractional area change (FAC), vector velocity imaging for longitudinal & derived circumferential deformation (peak radial displacement/end-diastolic diameter), and deformation ratio (longitudinal/ circumferential). Generalized Estimation Equations assessed temporal changes for each group and compared the interventions for each parameter. Independent T-test assessed outcomes.
Results: Hybrids (n=20) and Norwoods (n=27) had similar age, clinical status and echocardiogram parameters Pre-stage 1. Longitudinal analysis showed FAC was unchanged in Norwoods, while Hybrids decreased Pre-Glenn (p = 0.03) with return to baseline Pre-Fontan. Post stage 1, Norwoods increased circumferential and decreased longitudinal deformation (p<0.05), with a further increase in circumferential deformation Post-Glenn. Hybrids Post-stage 1 (no CPB) had similar change in contraction pattern, however circumferential deformation returned to baseline Pre-Glenn while longitudinal strain rate remained reduced (p<0.0001). Post-Glenn, Hybrids (after exposure to their first, and longer CPB), showed a decrease in both circumferential and longitudinal deformation (p<0.05). Comparing between interventions, Norwoods had greater circumferential (p<0.05) but similar longitudinal deformation post-stage 1 and Pre-Glenn. No other differences were found Post-Glenn including early clinical outcomes. Conclusions: HLHS Hybrids had similar change in RV contraction pattern as Norwoods post stage-1, suggesting inherent RV remodeling during early adaptation to single ventricle physiology. CPB at Norwood appears to modify this process by increasing reliance on RV circumferential contraction to maintain function.
Congenital Heart Disease RIGHT VENTRICULAR REMODELLING IN HYPOPLASTIC LEFT HEART SYNDROME: IMPACT OF THE NORWOOD AND HYBRID PROCEDURES Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Congenital Heart Disease: Innovations in Single Ventricle Heart Disease Abstract Category: 10. Congenital Heart Disease: Pediatric Presentation Number: 1182-010 Authors: Kandice Mah, Jesus Serrano Lomelin, Luke Eckersley, Lily Lin, Timothy Colen, Edythe Tham, Harald Becher, Luc Mertens, Nee Scze Khoo, Stollery Children’s Hospital, Edmonton, Canada, Sickkids, Toronto, Canada
Background: Right ventricular (RV) remodeling in hypoplastic left heart syndrome (HLHS) begins prenatally and continues through staged palliations. The impact of cardiopulmonary bypass (CPB) timing on HLHS RV remodeling, early in Norwood-Sano vs. later in Hybrid palliation, is unclear. Methods: Echocardiograms of HLHS patients undergoing stage-1 Norwood or Hybrid (Jan 2007 - Dec 2011) were longitudinally analyzed at Pre & Post-stage 1, Pre & Post-Glenn, and Pre-Fontan. We assessed RV fractional area change (FAC), vector velocity imaging for longitudinal & derived circumferential deformation (peak radial displacement/end-diastolic diameter), and deformation ratio (longitudinal/ circumferential). Generalized Estimation Equations assessed temporal changes for each group and compared the interventions for each parameter. Independent T-test assessed outcomes.
Results: Hybrids (n=20) and Norwoods (n=27) had similar age, clinical status and echocardiogram parameters Pre-stage 1. Longitudinal analysis showed FAC was unchanged in Norwoods, while Hybrids decreased Pre-Glenn (p = 0.03) with return to baseline Pre-Fontan. Post stage 1, Norwoods increased circumferential and decreased longitudinal deformation (p<0.05), with a further increase in circumferential deformation Post-Glenn. Hybrids Post-stage 1 (no CPB) had similar change in contraction pattern, however circumferential deformation returned to baseline Pre-Glenn while longitudinal strain rate remained reduced (p<0.0001). Post-Glenn, Hybrids (after exposure to their first, and longer CPB), showed a decrease in both circumferential and longitudinal deformation (p<0.05). Comparing between interventions, Norwoods had greater circumferential (p<0.05) but similar longitudinal deformation post-stage 1 and Pre-Glenn. No other differences were found Post-Glenn including early clinical outcomes. Conclusions: HLHS Hybrids had similar change in RV contraction pattern as Norwoods post stage-1, suggesting inherent RV remodeling during early adaptation to single ventricle physiology. CPB at Norwood appears to modify this process by increasing reliance on RV circumferential contraction to maintain function.