title: Head and neck vessel size by angiography predicts neo-aortic arch obstruction after Norwood/Sano operation for hypoplastic left heart syndrome.
abstract: OBJECTIVE
  To identify and predict neo-aortic arch obstruction (NAAO) in children after Norwood/Sano operation (NO) for hypoplastic left heart syndrome (HLHS).
  
  
  BACKGROUND
  NAAO is associated with morbidity and mortality after NO for HLHS and no objective measure has predicted the initial occurrence of NAAO. Computational flow models of aortic coarctation demonstrate increased wall shear stress (WSS) in vessels proximal to the coarctation segment, which we believe also occurs with NAAO. These vessels respond by increasing their luminal diameter to maintain normal WSS. We hypothesized that the relative increase in diameters of head and neck vessels to the isthmus, as measured by angiography, would identify hemodynamically significant NAAO and predict future NAAO.
  
  
  METHODS
  Retrospective review of patients with HLHS and at least one catheterization with aortic angiography after NO. Diameters of head and neck vessels were totaled and divided by the isthmus diameter to give a head and neck index (HNI), which was compared to coarctation index (CI) for identifying and predicting future NAAO.
  
  
  RESULTS
  Forty-four patients were identified, 17 with and 27 without NAAO. Receiver operator characteristic analysis using a value for CI ≤0.5 showed a sensitivity of 47% and specificity of 89%. For HNI, a value >2.65 gave a sensitivity of 77% and specificity of 93%. Three patients who developed NAAO after their initial catheterization had CI >0.5, but abnormally high HNI >2.65.
  
  
  CONCLUSIONS
  HNI is a more robust indicator of hemodynamically significant NAAO than CI and may predict its future occurrence after NO for HLHS.
authors: Cincinnati Children's Hospital Medical Center, Division of Cardiology, 3333 Burnet Ave, Cincinnati, OH 45299, USA. seckeler@hotmail.com
authors: Michael D
authors: MD
authors: Seckeler
authors: Frank J
authors: FJ
authors: Raucci
authors: Christine
authors: C
authors: Saunders
authors: James J
authors: JJ
authors: Gangemi
authors: Benjamin B
authors: BB
authors: Peeler
authors: K Anitha
authors: KA
authors: Jayakumar
mesh_terms: D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods*; D005260:Female; D006257:Head / Q000098:blood supply*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery; D007223:Infant; D008297:Male; D009333:Neck / Q000098:blood supply*; D058327:Norwood Procedures / Q000379:methods*; D011379:Prognosis