Associations between exercise-induced pulmonary haemorrhage, right ventricular dimensions and atrioventricular valve regurgitation in conditioned National Hunt racehorses

Introduction: Development of atrioventricular valve regurgitation (AVVR) with or without ventricular dysfunction (VD) often occurs during the first 6 months of life and has a significant impact on outcomes for single-ventricle patients. Yet, it is not well known whether AVVR causes VD or vice versa. Thus, we sought to identify the timing and causal relationship between AVVR and VD. Methods: Among 156 consecutive single-ventricle patients who had staged palliation (2005- 2012), 28 who had AVV repair at the time of stage II (n=24, 86%) or inter-stage (n=4, 14%) were reviewed. Diagnosis included HLHS in 17 (61%) patients, tricuspid atresia in 2 (7%), and others in 9 (32%). Ventricular morphology was left-dominant in 6 (21%) patients and right-dominant in 22 (79%). AVV morphology included mitral in 6 (21%) patients, tricuspid in 18 (64%), and common in 4 (14%). Serial echocardiograms were reviewed to identify the timing of development of AVVR and/or VD. Results: After stage I palliation, ventricular end-diastolic dimension (VEDD) z-score significantly increased from 4.01 to 5.69 (p<0.01) AVVR (Figure). By the time of stage II palliation, VEDD further increased and subsequent AVV annular dilation occurred, resulting in 23 patients with significant AVVR. None of the patients, however, had significant VD before stage II palliation/AVV repair, but 9 patients developed significant VD after AVV repair. Conclusions: Ventricular dilation occurred immediately after stage I palliation and continued until stage II palliation. Secondary annular dilation occurred inter-stage and this further triggered the development of AVVR. Tangible ventricular dysfunction was not seen before AVV repair, however, important ventricular dysfunction was unmasked after volume unloading surgery. Heart failure management and early intervention to significant AVVR may reduce the incidence of ventricular dysfunction following AVV repair.

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A Twenty-Month Experience Comparing Conventional Pulsed-Doppler Echocardiography and Color-Coded Digital Multigate Doppler, for Detection of Atrioventricular Valve Regurgitation, and Its Severity

Developments in Cardiovascular Medicine - Echocardiology ◽

10.1007/978-94-009-8299-4_44 ◽

1981 ◽

pp. 399-407 ◽

Cited By ~ 10

Author(s):

J. Geoffrey Stevenson ◽

Isamu Kawabori ◽

Marco A. Brandestini

Keyword(s):

Doppler Echocardiography ◽

Atrioventricular Valve ◽

Pulsed Doppler ◽

Valve Regurgitation ◽

Pulsed Doppler Echocardiography ◽

Atrioventricular Valve Regurgitation

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Survival and predictors of mortality in patients after the Fontan operation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320949655 ◽

2020 ◽

Vol 28 (9) ◽

pp. 572-576

Author(s):

Saviga Sethasathien ◽

Suchaya Silvilairat ◽

Hathaiporn Kraikruan ◽

Rekwan Sittiwangkul ◽

Krit Makonkawkeyoon ◽

...

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Fontan Operation ◽

Hazard Ratio ◽

Early Mortality ◽

Atrioventricular Valve ◽

Valve Regurgitation ◽

Artery Pressure ◽

Mean Pulmonary Artery Pressure ◽

Atrioventricular Valve Regurgitation

Background As a result of the surgical techniques now being employed, the survival rate in patients after undergoing the Fontan operation has improved. The aims of this study were focused on determining the survival rate and predictors of early mortality. Methods In a retrospective cohort study, 117 consecutive patients who underwent the Fontan operation were recruited. Multivariate Cox proportional regression analysis was used to assess the predictors of early mortality, defined as death within 30 days after the Fontan operation. Results The median follow-up time was 6.1 years. The median age at the time of the Fontan operation was 5.7 years. Survival rates in the patients at 5, 10, and 15 years postoperatively were 92%, 87% and 84%, respectively. Using univariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 26.0), renal failure (hazard ratio 9.5), heterotaxy syndrome (hazard ratio 5.3), and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 9.4). After adjusting for confounding factors using multivariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 23.2) and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 8.2). Conclusions Uncorrected moderate or severe atrioventricular valve regurgitation and postoperative mean pulmonary artery pressure ≥23 mm Hg are independent predictors of early mortality after the Fontan operation. Patients with these factors should undergo aggressive management to minimize morbidity and mortality.

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