title: Impact of initial norwood shunt type on right ventricular deformation: the single ventricle reconstruction trial.
abstract: BACKGROUND
  The Single Ventricle Reconstruction trial demonstrated a transplantation-free survival advantage at 12-month follow-up for patients with right ventricle-pulmonary artery shunts (RVPAS) with the Norwood procedure compared with modified Blalock-Taussig shunts but similar survival and decreased global right ventricular (RV) function on longer term follow-up. The impact of the required ventriculotomy for the RVPAS remains unknown. The aim of this study was to compare echocardiography-derived RV deformation indices after stage 2 procedures in survivors with single RV anomalies enrolled in the Single Ventricle Reconstruction trial.
  
  
  METHODS
  Global and regional RV systolic longitudinal and circumferential strain and strain rate, ejection fraction, and short-axis percentage fractional area change were all derived by speckle-tracking echocardiography from protocol echocardiograms obtained at 14.3 ± 1.2 months. Student t tests or Wilcoxon rank sum tests were used to compare groups.
  
  
  RESULTS
  The cohort included 275 subjects (129 in the modified Blalock-Taussig shunt group and 146 in the RVPAS group). Longitudinal deformation could be quantified in 214 subjects (78%) and circumferential measures in 182 subjects (66%). RV ejection fraction and percentage fractional area change did not differ between groups. There were no significant differences between groups for global or regional longitudinal deformation. Circumferential indices showed abnormalities in deformation in the RVPAS group, with decreased global circumferential strain (P = .05), strain rate (P = .09), and anterior regional strain rate (P = .07) that approached statistical significance.
  
  
  CONCLUSIONS
  RV myocardial deformation at 14 months, after stage 2 procedures, was not significantly altered by the type of initial shunt placed. However, abnormal trends were appreciated in circumferential deformation for the RVPAS group in the area of ventriculotomy that may represent early myocardial dysfunction. These data provide a basis for longer term RV deformation assessment in survivors after Norwood procedures.
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: ghill@chw.org.
authors.forename: Garick D
authors.initials: GD
authors.lastname: Hill
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Frommelt
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jessica
authors.initials: J
authors.lastname: Stelter
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: M Jay
authors.initials: MJ
authors.lastname: Campbell
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Meryl S
authors.initials: MS
authors.lastname: Cohen
authors.affiliation: Alfred I. DuPont Hospital for Children, Wilmington, Delaware.
authors.forename: Rami
authors.initials: R
authors.lastname: Kharouf
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Wyman W
authors.initials: WW
authors.lastname: Lai
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Jami C
authors.initials: JC
authors.lastname: Levine
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Jimmy C
authors.initials: JC
authors.lastname: Lu
authors.affiliation: University of Utah, Salt Lake City, Utah.
authors.forename: Shaji C
authors.initials: SC
authors.lastname: Menon
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Slesnick
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California.
authors.forename: Pierre C
authors.initials: PC
authors.lastname: Wong
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: David E
authors.initials: DE
authors.lastname: Saudek
mesh_terms: D058366:Blalock-Taussig Procedure / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007223:Infant; D008297:Male; D058327:Norwood Procedures / Q000379:methods*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Deformation; Norwood; Single ventricle; Strain; Strain rate