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
Secondary source ID ClinicalTrials.gov/NCT00115934 Grant support HL068288/HL/NHLBI NIH HHS/United States Z99 HL999999/NULL/Intramural NIH HHS/United States HL068285/HL/NHLBI NIH HHS/United States U01 HL068269/HL/NHLBI NIH HHS/United States U01 HL068279/HL/NHLBI NIH HHS/United States U01 HL068290/HL/NHLBI NIH HHS/United States HL068279/HL/NHLBI NIH HHS/United States U01 HL068288/HL/NHLBI NIH HHS/United States U10 HL068270/HL/NHLBI NIH HHS/United States U01 HL068281/HL/NHLBI NIH HHS/United States U01 HL068270/HL/NHLBI NIH HHS/United States HL085057/HL/NHLBI NIH HHS/United States HL068281/HL/NHLBI NIH HHS/United States U01 HL068292/HL/NHLBI NIH HHS/United States HL068269/HL/NHLBI NIH HHS/United States HL068270/HL/NHLBI NIH HHS/United States U01 HL085057/HL/NHLBI NIH HHS/United States HL068290/HL/NHLBI NIH HHS/United States U10 HL109673/HL/NHLBI NIH HHS/United States U01 HL068285/HL/NHLBI NIH HHS/United States HL068292/HL/NHLBI NIH HHS/United States