title: Right-ventricular global longitudinal strain may predict neo-aortic arch obstruction after Norwood/Sano procedure in children with hypoplastic left heart syndrome.
abstract: Neo-aortic arch obstruction (NAAO) is a common complication following the Norwood/Sano procedure (NP) for hypoplastic left heart syndrome (HLHS) and is associated with increased morbidity and mortality. However, there is currently no objective method for predicting which patients will develop NAAO. This study was designed to test the hypothesis that hemodynamic changes from development of NAAO after NP in patients with HLHS will lead to changes in myocardial dynamics that could be detected before clinical symptoms develop with strain analysis using velocity vector imaging. Patients with HLHS who had at least one cardiac catheterization after NP were identified retrospectively. Strain analysis was performed on all echocardiograms preceding the first catheterization and any subsequent catheterization performed for intervention on NAAO. Twelve patients developed NAAO and 30 patients never developed NAAO. Right ventricular strain was worse in the group that developed NAAO (-6.2 vs. -8.6 %, p = 0.040) at a median of 59 days prior to diagnosis of NAAO. Those patients that developed NAAO following NP were significantly younger at the time of first catheterization than those that did not develop NAAO (92 ± 50 vs. 140 ± 36 days, p = 0.001). This study demonstrates that right ventricular GLS is abnormal in HLHS patients following NP and worsening right ventricular strain may be predictive of the future development of NAAO.
authors: Department of Pediatrics, University of Virginia Health Systems, PO Box 800386, Charlottesville, VA, 22908, USA, fjr9v@virginia.edu.
authors: Frank J
authors: FJ
authors: Raucci
authors: Michael D
authors: MD
authors: Seckeler
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: D001015:Aortic Arch Syndromes / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011379:Prognosis; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
references: J Am Coll Cardiol. 2012 Nov 13;60(20):2074-81
references: 23083779
references: Cardiol Young. 2001 Jan;11(1):54-61
references: 11233398
references: Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004;7:22-31
references: 15283349
references: J Invasive Cardiol. 2013 Feb;25(2):73-5
references: 23388224
references: Eur J Radiol. 2012 Aug;81(8):e923-8
references: 22748555
references: Ann Thorac Surg. 1997 Dec;64(6):1795-802
references: 9436575
references: Echocardiography. 2008 Mar;25(3):294-307
references: 18307443
references: Am Heart J. 2000 Aug;140(2):227-31
references: 10925335
references: Ann Thorac Surg. 1991 Sep;52(3):688-95
references: 1898174
references: J Thorac Cardiovasc Surg. 2007 Jun;133(6):1540-6
references: 17532953
references: J Am Coll Cardiol. 2005 Jun 7;45(11):1844-8
references: 15936617
references: Ann Thorac Surg. 2008 Apr;85(4):1397-401; discussion 1401-2
references: 18355534
references: Ann Thorac Surg. 2011 Oct;92(4):1483-9; discussion 1489
references: 21872214
references: Am J Cardiol. 2000 Sep 15;86(6):697-9, A9
references: 10980230
references: Prenat Diagn. 2012 Oct;32(10):949-53
references: 22806693
references: Am Heart J. 1998 Feb;135(2 Pt 1):230-6
references: 9489969
references: J Am Soc Echocardiogr. 2006 Aug;19(8):1033-7
references: 16880099
references: J Am Coll Cardiol. 2011 Aug 16;58(8):868-76
references: 21835324
references: Ann Thorac Surg. 2004 Dec;78(6):1959-63; discussion 1963-4
references: 15561008