title: Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial.
abstract: Aortic arch reconstruction in children with single ventricle lesions may predispose to circulatory inefficiency and maladaptive physiology leading to increased myocardial workload. We sought to describe neoaortic anatomy and physiology, risk factors for abnormalities, and impact on right ventricular function in patients with single right ventricle lesions after arch reconstruction.
  
  
  
  Prestage II aortic angiograms from the Pediatric Heart Network Single Ventricle Reconstruction trial were analyzed to define arch geometry (Romanesque [normal], crenel [elongated], or gothic [angular]), indexed neoaortic dimensions, and distensibility. Comparisons were made with 50 single-ventricle controls without prior arch reconstruction. Factors associated with ascending neoaortic dilation, reduced distensibility, and decreased ventricular function on the 14-month echocardiogram were evaluated using univariate and multivariable logistic regression.
  
  
  
  Interpretable angiograms were available for 326 of 389 subjects (84%). Compared with controls, study subjects more often demonstrated abnormal arch geometry (67% vs 22%, P < .01) and had increased ascending neoaortic dilation (Z score 3.8 ± 2.2 vs 2.6 ± 2.0, P < .01) and reduced distensibility index (2.2 ± 1.9 vs 8.0 ± 3.8, P < .01). Adjusted odds of neoaortic dilation were increased in subjects with gothic arch geometry (odds ratio [OR], 3.2 vs crenel geometry, P < .01) and a right ventricle-pulmonary artery shunt (OR, 3.4 vs Blalock-Taussig shunt, P < .01) but were decreased in subjects with aortic atresia (OR, 0.7 vs stenosis, P < .01) and those with recoarctation (OR, 0.3 vs no recoarctation, P = .04). No demographic, anatomic, or surgical factors predicted reduced distensibility. Neither dilation nor distensibility predicted reduced right ventricular function.
  
  
  
  After Norwood surgery, the reconstructed neoaorta demonstrates abnormal anatomy and physiology. Further study is needed to evaluate the longer-term impact of these features.
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Plummer
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: Hamilton
authors.initials: H
authors.lastname: Baker
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Fleming
authors.affiliation: Children's Hospital of Wisconsin, Milwaukee, Wis.
authors.forename: Susan
authors.initials: S
authors.lastname: Foerster
authors.affiliation: Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga.
authors.forename: M Eric
authors.initials: ME
authors.lastname: Ferguson
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Russel
authors.initials: R
authors.lastname: Hirsch
authors.affiliation: Johns Hopkins Children's Heart Surgery, All Children's Hospital and Florida Hospital for Children, St Petersburg, Tampa, and Orlando, Fla.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Kyong-Jin
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, Calif.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Lewis
authors.affiliation: Duke University Medical Center, Durham, NC.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.affiliation: University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Mary
authors.initials: M
authors.lastname: Martin
authors.affiliation: Children's Hospital Boston, Boston, Mass.
authors.forename: Diego
authors.initials: D
authors.lastname: Porras
authors.affiliation: Nemours Children's Health System, Wilmington, Del.
authors.forename: Wolfgang A K
authors.initials: WA
authors.lastname: Radtke
authors.affiliation: Miami Children's Hospital, Miami, Fla.
authors.forename: John F
authors.initials: JF
authors.lastname: Rhodes
authors.affiliation: Columbia University Medical Center, New York, NY.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Vincent
authors.affiliation: University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Zampi
authors.affiliation: Duke University Medical Center, Durham, NC. Electronic address: kevin.hill@duke.edu.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hill
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D001027:Aortography; D016009:Chi-Square Distribution; D004108:Dilatation, Pathologic; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D058327:Norwood Procedures / Q000009:adverse effects*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D066253:Vascular Remodeling
keywords: Norwood; aorta; coarctation