Multicenter Study Comparing Shunt Type in the Norwood Procedure for Single-Ventricle Lesions Three-Dimensional Echocardiographic Analysis

• Authors: Gerald R. Marx, Boston Children's Hospital; Girish Shirali, Children's Mercy Hospitals and Clinics; Jami C. Levine, Boston Children's Hospital; Lin T. Guey, New England Research Institutes; James F. Cnota, Cincinnati Children's Hospital Medical Center; Jeanne M. Baffa, Alfred I. DuPont Hospital for Children; William L Border, Emory University; Steve Colan, Boston Children's Hospital; Gregory Ensing, University of Michigan; Mark K. Friedberg, Hospital for Sick Children; David J. Goldberg, Children's Hospital of Philadelphia; Salim F. Idriss, Duke University; J. Blaine John, Congenital Heart Institute of Florida; Wyman W. Lai, Columbia University; Minmin Lu, New England Research Institutes; Shaji C. Menon, University of Utah; Richard G. Ohye, University of Michigan; David Saudek, Medical College of Wisconsin; Pierre C. Wong, Children's Hospital Los Angeles; Gail D. Pearson, National Heart, Lung, and Blood Institute
• Journal Title: Circulation: Cardiovascular Imaging
• Volume: Volume 6, Number 6
• Publisher: American Heart Association | 2013-11-01, Pages 934-942
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/CIRCIMAGING.113.000304
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Radiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Radiology, Nuclear Medicine & Medical Imaging; Cardiovascular System & Cardiology; echocardiography; heart defects; congenital; pediatrics; LEFT-HEART SYNDROME; BIDIRECTIONAL CAVOPULMONARY ANASTOMOSIS; CARDIAC MAGNETIC-RESONANCE; EJECTION FRACTION; 3D ECHOCARDIOGRAPHY; IN-VITRO; VOLUME; MASS; ADAPTATION; VALIDATION

Abstract

Background-The Pediatric Heart Network's Single Ventricle Reconstruction (SVR) trial randomized infants with single right ventricles (RVs) undergoing a Norwood procedure to a modified Blalock-Taussig or RV-to-pulmonary artery shunt. This report compares RV parameters in the 2 groups using 3-dimensional echocardiography. Methods and Results-Three-dimensional echocardiography studies were obtained at 10 of 15 SVR centers. Of the 549 subjects, 314 underwent 3-dimensional echocardiography studies at 1 to 4 time points (pre-Norwood, post-Norwood, pre-stage II, and 14 months) for a total of 757 3-dimensional echocardiography studies. Of these, 565 (75%) were acceptable for analysis. RV volume, mass, mass:volume ratio, ejection fraction, and severity of tricuspid regurgitation did not differ by shunt type. RV volumes and mass did not change after the Norwood, but increased from pre-Norwood to pre-stage II (end-diastolic volume [milliliters]/body surface area [BSA]1.3, end-systolic volume [milliliters]/BSA1.3, and mass [grams]/BSA1.3 mean difference [95% confidence interval]=25.0 [8.7-41.3], 19.3 [8.3-30.4], and 17.9 [7.3-28.5], then decreased by 14 months (end-diastolic volume/BSA1.3, end-systolic volume/BSA1.3, and mass/BSA1.3 mean difference [95% confidence interval]=-24.4 [-35.0 to -13.7], -9.8 [-17.9 to -1.7], and -15.3 [-22.0 to -8.6]. Ejection fraction decreased from pre-Norwood to pre-stage II (mean difference [95% confidence interval]=-3.7 [-6.9 to -0.5]), but did not decrease further by 14 months. Conclusions-We found no statistically significant differences between study groups in 3-dimensional echocardiography measures of RV size and function, or magnitude of tricuspid regurgitation. Volume unloading was seen after stage II, as expected, but ejection fraction did not improve. This study provides insights into the remodeling of the operated univentricular RV in infancy.