399 Favorable Right Ventricular and Tricuspid Valve Remodeling in Patients With Hypoplastic Left Heart Syndrome After the Superior Bidirectional Cavopulmonary Anastomosis

2012 ◽  
Vol 28 (5) ◽  
pp. S249
Author(s):  
S. Ugaki ◽  
N. Khoo ◽  
D.B. Ross ◽  
I.M. Rebeyka ◽  
I. Adatia
Keyword(s):  
Right Ventricular ◽  
Hypoplastic Left Heart Syndrome ◽  
Tricuspid Valve ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Cavopulmonary Anastomosis ◽  
Valve Remodeling ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Left Heart Syndrome

Tricuspid Valve and Right Ventricular Function Throughout the Hybrid Palliation Strategy for Hypoplastic Left Heart Syndrome and Variants

2020 ◽  
pp. 215013512094769
Author(s):  
Sergio A. Carrillo ◽  
Karen M. Texter ◽  
Christina Phelps ◽  
Yubo Tan ◽  
Patrick I. McConnell ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Hypoplastic Left Heart Syndrome ◽  
Tricuspid Valve ◽  
Multiple Time ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Risk Of Death ◽  
Left Heart Syndrome ◽  
Rv Function ◽  
Hybrid Palliation

Background: Tricuspid valve (TV) and right ventricular (RV) function are major determinants of morbidity and mortality in patients with hypoplastic left heart syndrome (HLHS). We sought to retrospectively evaluate these parameters throughout the hybrid palliation strategy. Methods: From 2002 to 2018, 203 patients with HLHS and variants presented for hybrid stage I (HS1). Echocardiographic evaluation of tricuspid regurgitation (TR) and RV function was assessed at multiple time points. Clinical outcomes including tricuspid valvuloplasty, transplantation, and death were reviewed. Results: The most prevalent HLHS subtype was aortic atresia/mitral atresia. The presence of significant TR and/or RV dysfunction was 14.78% and 9.36%, respectively, at the time of initial HS1. There were 185 survivors following HS1 (91.13%, n = 185/203), while 147 patients underwent comprehensive stage II or bidirectional Glenn shunt (72.41%, n = 147/203). Tricuspid valvuloplasty was undertaken in nine patients (4.86%, n = 9/185). Ultimately, 100 patients underwent the Fontan procedure. The odds of development of significant TR and/or RV dysfunction were not statistically different throughout the stages of palliation (TR: odds ratio [OR] = 0.14-0.25, P = .5260; RV dysfunction: OR = 0.02-0.13, P = .3992). However, the risk of death and/or transplant was 2.5- to 3.8-fold when either were present alone or in combination (TR: OR = 2.58, P = .0356; RV dysfunction: OR = 3.84, P = .0262). Transplant-free survival at 15 years was 44.8%. Conclusion: Following hybrid palliation for HLHS, the majority of survivors have normal RV and TV functions. Tricuspid valvuloplasty was required in few patients. Once significant TR and/or RV dysfunction ensues, there is a two- to three-fold risk of death and/or transplant.

Impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after Fontan operation

2018 ◽  
Vol 28 (12) ◽  
pp. 1436-1443 ◽  
Author(s):  
Shuichi Shiraishi ◽  
Toshihide Nakano ◽  
Shinichiro Oda ◽  
Hideaki Kado
Keyword(s):  
Pulmonary Artery ◽  
Hypoplastic Left Heart Syndrome ◽  
Chest Tube ◽  
Total Cavopulmonary Connection ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Cavopulmonary Anastomosis ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Left Heart Syndrome ◽  
Cavopulmonary Connection

AbstractBackgroundsThe aim of this study was to assess the impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after total cavopulmonary connection.MethodsWe conducted a retrospective analysis of 100 consecutive patients who underwent total cavopulmonary connection from 2010 to 2014. All patients had previously undergone bidirectional cavopulmonary anastomosis. These patients were classified into two groups according to age at bidirectional cavopulmonary anastomosis: younger group, <6 months (n=33), and older group, >6 months (n=67).ResultsThe proportion of hypoplastic left heart syndrome was higher in the younger group (48 versus 4%). After total cavopulmonary connection, the chest tube period was longer in the younger group (10.1±6.6 versus 6.7±4.5 days; p=0.009). Catheterisation 6 months after total cavopulmonary connection revealed that pulmonary artery pressure was higher (11.5±1.9 versus 10.4±2.1 mmHg; p=0.017) and Nakata index was lower (219±79 versus 256±70 mm2/m2; p=0.024) in the younger group. In patients with a non-hypoplastic left heart syndrome, there was no difference in post-operative haemodynamics between two groups, but the total amount of chest drainage after total cavopulmonary connection was larger in the younger group (109±95 versus 55±40 ml/kg; p=0.044).ConclusionsEarly bidirectional cavopulmonary anastomosis did not affect the outcome of total cavopulmonary connection. Longer chest tube period, smaller pulmonary artery, and higher pulmonary artery pressure after total cavopulmonary connection were recognised in early bidirectional cavopulmonary anastomosis patients, especially in hypoplastic left heart syndrome.

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