Right ventricle function longitudinal evaluation after norwood procedure: comparison between right ventricle-pulmonary artery shunt and blalock-taussing shunt

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Borrelli ◽  
J Sabatino ◽  
M Avesani ◽  
M Josen ◽  
A Fraisse ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Surgical Techniques ◽  
Norwood Procedure ◽  
Number Of Patients ◽  
Before And After ◽  
Shunt Group ◽  
The Right ◽  
The Impact ◽  
Rv Function

Abstract Background Norwood procedure represents the first of three surgical steps toward Hypoplastic left heart syndrome (HLHS) complete palliation. Two are the main surgical techniques allowing the reconstruction of Norwood circulation: the right ventricle-pulmonary artery shunt (RVPAS) and the modified Blalock-Taussing shunt (mBTS). However, still little is known about the impact on right ventricle (RV) function of the required ventriculotomy for the RVPAS. Purpose The aim of the study was to investigate the changes in RV function in HLHS patients after RVPAS vs mBTS. Methods The cohort included 27 consecutive HLHS patients (10 in the modified Blalock-Taussig shunt group and 17 in the RVPAS group) who successfully underwent Norwood procedure in a single tertiary paediatric cardiology centre. Longitudinal strain (LS) and strain rate (LSR), tricuspid annulus peak systolic excursion (TAPSE) and fractional area change (FAC) were evaluated in all patients before Norwood and in three different breakpoints in the steady state after Norwood procedure (30 days after Norwood, 90 days after Norwood, 140 days after Norwood). Results Ventricular loading conditions (diuretic treatment, blood pressure and tricuspid regurgitation) were similar in both groups. No significant differences were found at different time points between RVPAS and mBTS group in terms of LS, LSR, TAPSE and FAC. However, when we compared RV function before and after Norwood procedure, 90 days after the procedure, patients who did not undergo RV ventriculotomy (mBTS group) showed significant improvement in LS compared to pre-surgical assessment (mBTS: +27.35±43.47% vs RVPAS: −8,20±25.25%, p=0,03). This finding was consistent but no longer statistically significant at 140 days after Norwood (mBTS: +13.81±21.99% vs RVPAS: −4.90±27.97%, p=0,12). Conclusion After Norwood procedure mBTS patients showed a significant increase in LS when compared with patients who underwent RVPAS. This finding was consistent but no longer significant at 140 days after Norwood probably because the number of patients was too small to reach a significant level. These data support the use of LS in HLHS patient's evaluation and may be of value to find a patient-tailored timing for the second surgical stage. TAPSE, FAC, LS and LSR trends Funding Acknowledgement Type of funding source: None

scholarly journals Evaluation of the morphology and mechanics of the right ventricle using echocardiography before and after transcatheter balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
KIRILL Malikov ◽  
MARINA Kirichkova ◽  
MARIA Simakova ◽  
NARECK Marukyan ◽  
OLGA Moiseeva
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Pulmonary Artery Pressure ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Reverse Remodeling ◽  
Free Wall ◽  
Artery Pressure ◽  
Balloon Pulmonary Angioplasty ◽  
Before And After ◽  
The Right

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) leads to a progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) with the development of severe dysfunction of the right heart and heart failure. Mortality for three years with an average pressure in the pulmonary artery (PA) of more than 50 mmHg is more than 90%. Balloon pulmonary angioplasty (BPA) has a significant advantage over other methods of surgical treatment, but it requires the determination of additional non-invasive markers of effectiveness. Transthoracic echocardiography (TTE) remains the main method for assessing the morphology and function of the heart. Purpose Compare different indicators reflecting the severity of CTEPH with TTE indicators before and after BPA. To evaluate the effectiveness of using BPA for the treatment of patients with CTEPH using routine TTE and speckle tracking mode. Materials and methods For 18 months 30 patients without concomitant cardiovascular pathology were subjected to several BPA sessions. Before treatment, 50% of patients belonged to the 3 CTEPH functional class (FC), 40% to 2 FC, 10% to 1 FC. The average number of sessions was 4.7 ± 1.3. Before the first BPA and after the last, all the patients were performed: six-minute walk test (6MWT, metres), Borg scale (in points), test for NT-proBNP (pg/ml); TTE with assessment of the right ventricle (RV) and left ventricle (LV) including areas of the right atrium (aRA, cm2), mean pulmonary artery pressure (PUPM,mmHg),RV free wall strain (GLSFW, %), RV free wall strain rate (GLSRFW, sm/sec), RV free wall postsystolic shortening (PSSFW, %), tricuspid annular plane systolic excursion (TAPSE, sm), tricuspid annulus systolic velocity (TASV, sm/sec). Results. Before the first BPA session, the 6MWT in the patient group averaged 315.9 ± 9.08 metres, after - 439.5 ± 11.45 m; the Borg from 5.4 ± 0.94 points decreased to 4 ± 1.01 points; NT-proBNP before the treatment was 1513 ± 13.01 pg/ml, after - 171 ± 6.09; according to TTE the ratio of RV/ LV before and after treatment was 1.31 ± 0.02 and 0.97 ± 0.04; aRA was 29.3 ± 4.87 and 22.3 ± 3.53 cm2; basal RV - 52 ± 5.11 and 44 ± 7.26 mm; PUPM decreased from 76.6 ± 7.65 to 31.3 ± 3.78 mmHg; GLSFW from -14.69 ± 2.33 came to 17.5 ± 3.45 %; GLSRFW with -0.9 ± 0.09 to -1.7 ± 0.11 cm/sec; TAPSE from 16.7 ± 1.87 to 18.2 ± 2.34 cm; TASV from 10.11 ± 1.45 to 12.25 ± 1.98 cm/s, PSSFW before treatment was -18.4 ± 1.2%, after treatment in 66% of patients disappeared, in 34% became an average of 17.4 ± 0.9% The distribution of STEPH FC has also changed. Conclusion. BPA leads to an improvement in the tolerance of physical activity, clinical indicators, and parameters of central hemodynamics in the pulmonary circulation, evaluated according to direct manometry, and leads to reverse remodeling of the RV in the long term. Performing a staged BPA leads to an improvement in the functional parameters of contractility of the RV.

The Modified Blalock–Taussig Shunt Versus the Right Ventricle-to-Pulmonary Artery Conduit for the Norwood Procedure

2007 ◽  
Vol 28 (2) ◽  
pp. 122-125 ◽  
Author(s):  
Richard G. Ohye ◽  
Eric J. Devaney ◽  
Jennifer C. Hirsch ◽  
Edward L. Bove
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Norwood Procedure ◽  
The Right ◽  
Artery Conduit ◽  
Blalock Taussig Shunt

scholarly journals The Norwood procedure using a right ventricle–pulmonary artery conduit: Comparison of the right-sided versus left-sided conduit position

2009 ◽  
Vol 138 (3) ◽  
pp. 528-537 ◽  
Author(s):  
David J. Barron ◽  
Andre Brooks ◽  
John Stickley ◽  
Steven M. Woolley ◽  
Oliver Stümper ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Norwood Procedure ◽  
The Right ◽  
Artery Conduit

scholarly journals Usefulness of balloon angioplasty for the right ventricle-pulmonary artery shunt with the modified norwood procedure

2012 ◽  
Vol 81 (5) ◽  
pp. 837-842
Author(s):  
Naoki Ohno ◽  
Shinichi Ohtsuki ◽  
Koichi Kataoka ◽  
Kenji Baba ◽  
Yoshio Okamoto ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Balloon Angioplasty ◽  
Norwood Procedure ◽  
The Right

scholarly journals Size of the right ventricle-to-pulmonary artery conduit impacts mid-term outcome after the Norwood procedure in patients weighing less than 3 kg

2012 ◽  
Vol 144 (5) ◽  
pp. 1091-1094 ◽  
Author(s):  
Naruhito Watanabe ◽  
Petros V. Anagnostopoulos ◽  
Takeshi Shinkawa ◽  
Natalie Johnson ◽  
Anthony Azakie
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Norwood Procedure ◽  
Term Outcome ◽  
The Right ◽  
Artery Conduit

scholarly journals Decreasing Interstage Mortality After the Norwood Procedure: A 30‐Year Experience

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Michelle Kaplinski ◽  
Richard F. Ittenbach ◽  
Mallory L. Hunt ◽  
Donna Stephan ◽  
Shobha S. Natarajan ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Hypoplastic Left Heart Syndrome ◽  
Monitoring Program ◽  
Norwood Procedure ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Interstage Mortality ◽  
The Right ◽  
Left Heart Syndrome

Background The superior cavo‐pulmonary connection was introduced at our institution in 1988 for infants undergoing surgery for hypoplastic left heart syndrome. Patients with hypoplastic left heart syndrome remain at high risk for mortality in the time period between the Norwood procedure and the superior cavo‐pulmonary connection. The primary objectives of this study were to compare interstage mortality across 4 eras and analyze factors that may impact interstage mortality. Methods and Results Patients with hypoplastic left heart syndrome who underwent the Norwood procedure, were discharged from the hospital, and were eligible for superior cavo‐pulmonary connection between January 1, 1988, and December 31, 2017, were included. The study period was divided into 4 eras based on changes in operative or medical management. Mortality rates were estimated with 95% CIs. Adjusted and unadjusted logistic regression models were used to identify risk factors for mortality. There were 1111 patients who met the inclusion criteria. Overall, interstage mortality was 120/1111 (10.8%). Interstage mortality was significantly lower in era 4 relative to era 1 (4.6% versus 13.4%; P =0.02) during the time that age at the superior cavo‐pulmonary connection was the lowest (135 days; P <0.01) and the interstage monitoring program was introduced. In addition, use of the right ventricle to pulmonary artery shunt was associated with decreased interstage mortality ( P =0.02) and was more routinely practiced in era 4. Conclusions During this 30‐year experience, the risk of interstage mortality decreased significantly in the most recent era. Factors that coincide with this finding include younger age at superior cavo‐pulmonary connection, introduction of an interstage monitoring program, and increased use of the right ventricle to pulmonary artery shunt.

scholarly journals Norwood procedure with right ventricle to pulmonary artery conduit: a single-centre 20-year experience

2020 ◽  
Vol 58 (2) ◽  
pp. 230-236
Author(s):  
Yasuyuki Kobayashi ◽  
Yasuhiro Kotani ◽  
Yosuke Kuroko ◽  
Takuya Kawabata ◽  
Shunji Sano ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Ventricular Function ◽  
Norwood Procedure ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Number Of Patients ◽  
Anomalous Pulmonary Vein ◽  
Stage 1 ◽  
Hypoplastic Left Heart Complex

Abstract OBJECTIVES The aim of this study was to evaluate the long-term outcomes of the Norwood procedure with right ventricle–pulmonary artery (RV–PA) conduit for hypoplastic left heart complex. METHODS A retrospective observational study was performed in 136 patients with hypoplastic left heart complex who underwent a Norwood procedure with RV–PA conduit between 1998 and 2017. The probabilities of survival, reintervention and Fontan completion were analysed. RESULTS Stage 1 survival was 91.9% (125/136). Reintervention for PA stenosis was needed for 22% and 30% at stages 2 and 3, respectively, while 15% underwent reintervention for aortic arch recoarctation. Among 106 bidirectional Glenn survivors, 93 (68% of the total number of patients) had a Fontan completion, while 4 were not considered to be Fontan candidates. Risk factors for overall mortality included weighing &lt;2.5 kg at the time of the Norwood procedure, intact atrium septum, total anomalous pulmonary vein connection and more than mild atrioventricular regurgitation at the time of the Norwood procedure. Overall survival was 80.9%, 72.3% and 62.8% at 1, 5 and 20 years, respectively. CONCLUSIONS Probabilities of survival and Fontan completion were acceptable under the current surgical strategy incorporating RV–PA Norwood procedure as the first palliation. Incorporating a strategy to maintain PA growth and ventricular function through the staged repair is of prime importance. Further studies are necessary to observe changes in atrioventricular regurgitation as well as in right ventricular function, in patients who require atrioventricular valve interventions during the staged Fontan completion.

Transthoracic Right Heart Echocardiography for the Intensivist

2021 ◽  
pp. 088506662110034
Author(s):  
Maxwell A. Hockstein ◽  
Korbin Haycock ◽  
Matthew Wiepking ◽  
Skyler Lentz ◽  
Siddharth Dugar ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Heart Function ◽  
Salient Feature ◽  
Left Ventricular ◽  
Response To Therapy ◽  
Right Heart ◽  
Clinical Scenarios ◽  
The Right ◽  
The Impact ◽  
Rv Function

Background: The impact of critical illness on the right ventricle (RV) can be profound and RV dysfunction is associated with mortality. Intensivists are becoming more facile with bedside echocardiography, however, pedagogy has largely focused on left ventricular function. Here we review measurements of right heart function by way of echocardiographic modalities and list clinical scenarios where the RV dysfunction is a salient feature. Main: RV dysfunction is heterogeneously defined across many domains and its diagnosis is not always clinically apparent. The RV is affected by conditions commonly seen in the ICU such as acute respiratory distress syndrome, pulmonary embolism, RV ischemia, and pulmonary hypertension. Basic ultrasonographic modalities such as 2D imaging, M-mode, tissue Doppler, pulsed-wave Doppler, and continuous Doppler provide clinicians with metrics to assess RV function and response to therapy. Conclusion: The right ventricle is impacted by various critical illnesses with substantial mortality and mortality. Focused bedside echocardiographic exams with attention to the right heart may provide intensivists insight into RV function and provide guidance for patient management.

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