Neonates with hypoplastic left heart syndrome have ultrasound evidence of abnormal superior mesenteric artery perfusion before and after modified Norwood procedure.
OBJECTIVE
To a) describe superior mesenteric artery resistive index, as an estimate of perfusion, before and after modified Norwood; and b) assess incidence of diastolic flow reversal in the superior mesenteric artery before and after modified Norwood.


METHODS
Prospective observational trial.


METHODS
Children's hospital pediatric intensive care unit.


METHODS
Ten newborns with hypoplastic left heart syndrome.


METHODS
Ultrasound documentation of superior mesenteric artery diastolic flow direction and measurement of superior mesenteric artery resistive index 24-48 hrs before and 24-48 hrs after modified Norwood.


RESULTS
Seven males and three females were enrolled. There was no change between the superior mesenteric artery resistive index pre- vs. postoperatively-0.99 (95% confidence interval, 0.85, 1.12) vs. 1.07 (95% confidence interval, 1.0, 1.15) (p = .13). Incidence of retrograde diastolic blood flow in the superior mesenteric artery was not different pre- vs. postoperatively (70% vs. 50%, p = .41). No patients developed necrotizing enterocolitis and all survived to hospital discharge.


CONCLUSIONS
Ultrasound measurements in neonates with hypoplastic left heart syndrome suggest that superior mesenteric artery perfusion, as measured by resistive index, is impaired. Superior mesenteric artery diastolic flow reversal is common before and immediately after modified Norwood.
Department of Pediatric Critical Care Medicine, Children's Hospital, Cleveland Clinic Foundation, Cleveland, OH, USA.
A Marc
AM
Harrison
Steve
S
Davis
Janet R
JR
Reid
Stuart C
SC
Morrison
Susana
S
Arrigain
Jason T
JT
Connor
Mary E
ME
Temple
D020345:Enterocolitis, Necrotizing / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology*; D019990:Perioperative Care; D011446:Prospective Studies; D013152:Splanchnic Circulation; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance