Multicenter study comparing shunt type in the norwood procedure for single-ventricle lesions: three-dimensional echocardiographic analysis.
PMCID: PMC3904745 DOI: 10.1161/CIRCIMAGING.113.000304
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]/BSA(1.3), and mass [grams]/BSA(1.3) 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/BSA(1.3), end-systolic volume/BSA(1.3), and mass/BSA(1.3) 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.
Circ Cardiovasc Imaging
Child, Preschool; Echocardiography, Three-Dimensional; Female; Heart Ventricles; Humans; Hypoplastic Left Heart Syndrome; Male; Norwood Procedures; Pulmonary Artery; Treatment Outcome
ECG; CHD; congenital heart defects; pediatrics
Marx, G. R., Shirali, G. S., Levine, J. C., Guey, L. T., Cnota, J. F., Baffa, J. M., Border, W. L., Colan, S., Ensing, G., Friedberg, M. K., Goldberg, D. J., Idriss, S. F., John, J. B., Lai, W. W., Lu, M., Menon, S. C., Ohye, R. G., Saudek, D., Wong, P. C., Pearson, G. D., . Multicenter study comparing shunt type in the norwood procedure for single-ventricle lesions: three-dimensional echocardiographic analysis. Circ Cardiovasc Imaging 6, 934-942 (2013).
Cardiology Commons, Cardiovascular System Commons, Congenital, Hereditary, and Neonatal Diseases and Abnormalities Commons, Pediatrics Commons, Surgical Procedures, Operative Commons
Secondary source ID ClinicalTrials.gov/NCT00115934_x000D_