title: Echocardiographic parameters that predict outcome in aortic atresia patients undergoing comprehensive stage II procedure.
abstract: BACKGROUND
  The hybrid procedure is one option for palliating patients with hypoplastic left heart syndrome. As experience increases with this palliation, the physiology and its influence on outcome can be better assessed. The goal of this study was to determine if echocardiographic parameters correlate with post-operative variables in patients with aortic atresia undergoing the comprehensive Stage II procedure.
  
  
  METHODS
  Retrospective chart review on all patients with aortic atresia, who underwent the comprehensive Stage II procedure from January 2002 to December 2008, was performed. Echocardiographic indices were evaluated and correlations were made with peri-operative and hospital variables. Pair-wise Pearson's correlation tests were used to analyze the associations between continuous measures.
  
  
  RESULTS
  Thirty-four patients met inclusion criteria. Age at comprehensive Stage II procedure was 0.45 ± 0.13 years and body surface area was 0.31 ± 0.04 m(2). Right ventricle (RV) percentage change was 45 ± 10%, eccentricity index was 1.96 ± 0.45, estimated systemic cardiac output was 7.68 ± 2.56 L/min/m(2) and estimated effective systemic cardiac output was 5.15 ± 2.24 L/min/m(2). Retrograde patent ductus arteriosu (PDA) velocity time integral (VTI) correlated with log pre-bypass lactate and maximum lactate (r = 0.53, 0.44). PDA regurgitant fraction correlated with log post-bypass lactate, length of intubation, and urine output on day four (r = 0.39, 0.46, -0.37). RV percentage change correlated with log pre-bypass lactate, and urine output on days four and five (r =-0.38, 0.43, 0.54). No echocardiographic parameter predicted renal or liver insufficiency, dialysis, extracorporeal membrane oxygenation use, or hospital death.
  
  
  CONCLUSIONS
  Retrograde PDA VTI and RV percent change correlated with some peri-operative variables though no echocardiographic parameter was associated with any major morbidities or mortality. Newer echocardiographic techniques may better predict comprehensive stage II outcomes.
authors.affiliation: Department of Pediatrics, Heart Center Nationwide Childrens Hospital, Columbus, Ohio, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Birnbaum
authors.forename: Glen
authors.initials: G
authors.lastname: Berger
authors.forename: Bernadette
authors.initials: B
authors.lastname: Fenstermaker
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Rowland
authors.forename: Bethany
authors.initials: B
authors.lastname: Boettner
authors.forename: Vince
authors.initials: V
authors.lastname: Olshove
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.forename: John P
authors.initials: JP
authors.lastname: Cheatham
authors.forename: Clifford L
authors.initials: CL
authors.lastname: Cua
mesh_terms: D001830:Body Surface Area; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000601:surgery; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D015199:Extracorporeal Membrane Oxygenation; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D008107:Liver Diseases / Q000209:etiology; D009820:Ohio; D010166:Palliative Care; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome