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Author Notes:

Correspondence: Kevin D. Hill, MD, MS, Duke Clinical Research Institute, 2400 Pratt St., Durham, NC 27705 (kevin.hill@duke.edu)

The views expressed in this article are those of the individual authors and do not represent official views of the National Heart, Lung, and Blood Institute or National Institutes of Health.

Conflict of Interest Statement: C.P.H., J.S.L., and K.D.H. receive support from the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001117).

All other authors have nothing to disclose with regard to commercial support.

Subjects:

Research Funding:

Funded by Grant Numbers HL068269, HL068270, HL068279, HL068281, HL068285, HL068292, HL068290, HL068288, HL085057, HL109737, and HL085057 from the National Heart, Lung, and Blood Institute.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Respiratory System
  • Surgery
  • Cardiovascular System & Cardiology
  • Norwood
  • aorta
  • coarctation
  • COMPUTATIONAL FLUID-DYNAMICS
  • PULMONARY AUTOGRAFT DILATATION
  • ARTERIAL SWITCH OPERATION
  • MODIFIED ROSS OPERATION
  • INITIAL SHUNT TYPE
  • ROOT DILATION
  • CAVOPULMONARY CONNECTIONS
  • SUCCESSFUL REPAIR
  • FONTAN PROCEDURE
  • ASCENDING AORTA

Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial

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Journal Title:

Journal of Thoracic and Cardiovascular Surgery

Volume:

Volume 152, Number 2

Publisher:

, Pages 471-479.e3

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Objectives: 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. Methods: 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. Results: 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. Conclusions: After Norwood surgery, the reconstructed neoaorta demonstrates abnormal anatomy and physiology. Further study is needed to evaluate the longer-term impact of these features.

Copyright information:

© 2016 The American Association for Thoracic Surgery

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