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Effect of Hybrid stage 1 procedure on ventricular function in infants with hypoplastic left heart syndrome*

Published online by Cambridge University Press:  08 September 2015

Daisuke Kobayashi ,
Girija Natarajan ,
Daniel R. Turner ,
Thomas J. Forbes ,
Ralph E. Delius ,
Henry L. Walters III  and
Sanjeev Aggarwal
Daisuke Kobayashi
Affiliation:
Carman and Ann Adams Department of Pediatrics, Division of Cardiology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Girija Natarajan
Affiliation:
Department of Neonatology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Daniel R. Turner
Affiliation:
Carman and Ann Adams Department of Pediatrics, Division of Cardiology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Thomas J. Forbes
Affiliation:
Carman and Ann Adams Department of Pediatrics, Division of Cardiology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Ralph E. Delius
Affiliation:
Department of Cardiovascular Surgery, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Henry L. Walters III
Affiliation:
Department of Cardiovascular Surgery, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
Sanjeev Aggarwal*
Affiliation:
Carman and Ann Adams Department of Pediatrics, Division of Cardiology, Wayne State University School of Medicine, Detroit, Michigan, United States of America
*
Correspondence to: S. Aggarwal, MD, Associate Professor, Carman and Ann Adams Department of Pediatrics, Division of Cardiology, Wayne State University School of Medicine, Children’s Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201-2119, United States of America. Tel: +1 313 745 6105; Fax: +1 313 993 0894; E-mail: ssanjeev@dmc.org
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Abstract

Objective

The effect of Hybrid stage 1 palliation for hypoplastic left heart syndrome on right ventricular function is unknown. We sought to compare right ventricular function in normal neonates and those with hypoplastic left heart syndrome before Hybrid palliation and to assess the effect of Hybrid palliation on right ventricular function, using the right ventricular myocardial performance index and the ratio of systolic and diastolic durations.

Methods

We carried out a retrospective review of echocardiographic data on 23 infants with hypoplastic left heart syndrome who underwent Hybrid palliation and 35 normal controls. Data were acquired before Hybrid and after Hybrid palliation – post 1, 0–4 days; post 2, 1 week; post 3, 2–3 weeks; post 4, 1–1.5 months following Hybrid palliation.

Results

Myocardial performance index and ratio of systolic and diastolic durations were higher in the pre-Hybrid hypoplastic left heart syndrome group (n=23) – 0.47±0.16 versus 0.25±0.07, p<0.001; 1.59±0.44 versus 1.09±0.14, p<0.0001 – compared with controls (n=35). There was no significant change in the myocardial performance index at any of the post-Hybrid time points. Ratio of systolic and diastolic durations increased significantly 2 weeks after Hybrid – post 3: 2.08±0.62 and post 4: 2.21±0.45 versus pre: 1.59±0.44, p=0.043 and 0.003. There were no significant differences in parameters between sub-groups of infants who died (n=10) and survivors (n=13).

Conclusions

Right ventricular myocardial performance index and ratio of systolic and diastolic durations were significantly higher in infants with hypoplastic left heart syndrome before intervention compared with controls. The ratio of systolic and diastolic durations increased significantly 2 weeks after Hybrid palliation. Our data suggest that infants with hypoplastic left heart syndrome have right ventricular dysfunction before intervention, which worsens over 2 weeks after Hybrid palliation.

Keywords

Hypoplastic left heart syndromeHybrid stage 1 procedureventricular functionmyocardial performance indexratio of systolic and diastolic durations
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 867 - 875
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Copyright
© Cambridge University Press 2015 

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Footnotes

*

All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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