Effect of Hybrid stage 1 procedure on ventricular function in infants with hypoplastic left heart syndrome.
OBJECTIVE
The effect of Hybrid stage 1 palliation for hypoplastic left heart syndrome on right ventricular function is unknown. We sought to compare right ventricular function in normal neonates and those with hypoplastic left heart syndrome before Hybrid palliation and to assess the effect of Hybrid palliation on right ventricular function, using the right ventricular myocardial performance index and the ratio of systolic and diastolic durations.


METHODS
We carried out a retrospective review of echocardiographic data on 23 infants with hypoplastic left heart syndrome who underwent Hybrid palliation and 35 normal controls. Data were acquired before Hybrid and after Hybrid palliation - post 1, 0-4 days; post 2, 1 week; post 3, 2-3 weeks; post 4, 1-1.5 months following Hybrid palliation.


RESULTS
Myocardial performance index and ratio of systolic and diastolic durations were higher in the pre-Hybrid hypoplastic left heart syndrome group (n=23) - 0.47±0.16 versus 0.25±0.07, p<0.001; 1.59±0.44 versus 1.09±0.14, p<0.0001 - compared with controls (n=35). There was no significant change in the myocardial performance index at any of the post-Hybrid time points. Ratio of systolic and diastolic durations increased significantly 2 weeks after Hybrid - post 3: 2.08±0.62 and post 4: 2.21±0.45 versus pre: 1.59±0.44, p=0.043 and 0.003. There were no significant differences in parameters between sub-groups of infants who died (n=10) and survivors (n=13).


CONCLUSIONS
Right ventricular myocardial performance index and ratio of systolic and diastolic durations were significantly higher in infants with hypoplastic left heart syndrome before intervention compared with controls. The ratio of systolic and diastolic durations increased significantly 2 weeks after Hybrid palliation. Our data suggest that infants with hypoplastic left heart syndrome have right ventricular dysfunction before intervention, which worsens over 2 weeks after Hybrid palliation.
1Carman and Ann Adams Department of Pediatrics,Division of Cardiology,Wayne State University School of Medicine,Detroit,Michigan,United States of America.
Daisuke
D
Kobayashi
2Department of Neonatology,Wayne State University School of Medicine,Detroit,Michigan,United States of America.
Girija
G
Natarajan
1Carman and Ann Adams Department of Pediatrics,Division of Cardiology,Wayne State University School of Medicine,Detroit,Michigan,United States of America.
Daniel R
DR
Turner
1Carman and Ann Adams Department of Pediatrics,Division of Cardiology,Wayne State University School of Medicine,Detroit,Michigan,United States of America.
Thomas J
TJ
Forbes
3Department of Cardiovascular Surgery,Children's Hospital of Michigan,Wayne State University School of Medicine,Detroit,Michigan,United States of America.
Ralph E
RE
Delius
3Department of Cardiovascular Surgery,Children's Hospital of Michigan,Wayne State University School of Medicine,Detroit,Michigan,United States of America.
Henry L
HL
Walters
1Carman and Ann Adams Department of Pediatrics,Division of Cardiology,Wayne State University School of Medicine,Detroit,Michigan,United States of America.
Sanjeev
S
Aggarwal
D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D016022:Case-Control Studies; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D013599:Systole; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology*; D016278:Ventricular Function, Right
Hybrid stage 1 procedure; Hypoplastic left heart syndrome; myocardial performance index; ratio of systolic and diastolic durations; ventricular function