scholarly journals INCREASED PRELOAD AND AFTERLOAD STRESSORS DURING THE FIRST INTERSTAGE MAY UNMASK IMPAIRED RIGHT VENTRICULAR CONTRACTILE RESERVE IN HYPOPLASTIC LEFT HEART SYNDROME (HLHS): A LONGITUDINAL SPECKLE TRACKING ECHOCARDIOGRAPHY STUDY

2018 ◽  
Vol 34 (10) ◽  
pp. S55-S56
Author(s):  
L. Lin ◽  
E. Tham ◽  
S. Islam ◽  
S. Alvarez ◽  
K. Mah ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Hypoplastic Left Heart Syndrome ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Contractile Reserve ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Left Heart Syndrome

P2739Can cardiac mechanics predict outcome in hypoplastic left heart syndrome patients? A speckle tracking echocardiography study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N S Borrelli ◽  
G Di Salvo ◽  
J Sabatino ◽  
M Spada ◽  
G Delle Donne ◽  
...  
Keyword(s):  
Hypoplastic Left Heart Syndrome ◽  
Preliminary Data ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Composite Endpoint ◽  
High Morbidity ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Cavopulmonary Anastomosis ◽  
Left Heart Syndrome

Abstract Introduction Hypoplastic Left Heart Syndrome (HLHS) still carries a high morbidity and mortality. Right ventricle (RV) dysfunction is one of the most important responsible of a worse outcome. Unfortunately, RV assessment is a challenge. Speckle tracking echocardiography (STE) demonstrated an excellent ability in the estimation of RV function. Purpose The aim of our study is to evaluate the ability of STE and standard 2D echo parameters in predicting death and need for heart transplantation (HT) in HLHS patients. Methods 31 patients with diagnosis of HLHS successfully completed Norwood (n=29) or comprehensive Norwood stage II at our Institution between 2016 and 2018. Survival at 6 months was 93.3%, survival at 18 months was 81.1%. We present our preliminary data on 23 HLHS patients (13 male). All the studied patients underwent in-hospital interstage stay. Serial echocardiographic assessments were performed in all the included patients (baseline, one month after Norwood, three months after Norwood, one week before bidirectional cavopulmonary anastomosis [BCPA] and two months after BCPA). From apical view we measured: tricuspid annulus peak systolic excursion (TAPSE), fractional area change (FAC), longitudinal strain (LS) and strain rate (LSR). Results After a median follow-up of 2.2 years (1.7–2.6 years), 6 out of 23 patients met the composite endpoint of death/HT. At pre-Norwood assessment, there was no statistical difference between survivor and death/HT patients. In death/HT group TAPSE declined at one-month after Norwood procedure. LS decreased significantly at three-months after Norwood. After BCPA, death/HT patients had much lower FAC, TAPSE, LS and LSR than survived patients. At one-month evaluation, TAPSE ≤5 mm had a good specificity for death/HT (80%) and a moderate sensitivity (70.6%) with an area under the curve (AUC) of 0.80. Still at one-month evaluation, Δ LS ([{baseline LS – one-month post Norwood LS}/ baseline LS] *100) >7.7% showed a 100% sensibility and moderate specificity (76.5%) for death/HT (AUC 0.841). LS in HLHS patient and LS ROC curve. Conclusions HLHS patients with TAPSE ≤5 mm and Δ LS of >7.7% one-month after Norwood had a high likelihood of death or HT. These preliminary data encourage the routine use of TAPSE and LS to monitor cardiac function in HLHS patients and to identify subgroup patients at high risk.

Comparison of right ventricular deformation and dyssynchrony in patients with different subtypes of hypoplastic left heart syndrome after Fontan surgery using two-dimensional speckle tracking

2011 ◽  
Vol 21 (6) ◽  
pp. 677-683 ◽  
Author(s):  
Colin Petko ◽  
Inga Voges ◽  
Jana Schlangen ◽  
Jens Scheewe ◽  
Hans-Heiner Kramer ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Right Ventricular ◽  
Hypoplastic Left Heart Syndrome ◽  
Speckle Tracking ◽  
Two Dimensional ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Intraventricular Dyssynchrony ◽  
Fontan Surgery ◽  
Left Heart Syndrome

AbstractBackgroundThe left ventricle in patients with hypoplastic left heart syndrome may influence right ventricular function and outcome. We aimed to investigate differences in right ventricular deformation and intraventricular dyssynchrony between hypoplastic left heart syndrome patients with different anatomical subtypes and left ventricle sizes after Fontan surgery using two-dimensional speckle tracking.Patients and methodsWe examined 29 hypoplastic left heart syndrome patients aged 5.4 plus or minus 2.8 years after Fontan surgery and compared 15 patients with mitral and aortic atresia with the remaining 14 patients with other anatomic subtypes. We used two-dimensional speckle tracking to measure the global and regional systolic longitudinal strain and strain rate as well as intraventricular dyssynchrony.ResultsGlobal strain (−19.5, 2.8% versus −17.4, 3.9%) and global strain rate (−1.0, 0.2 per second versus −0.9, 0.3 per second) were not different between groups. The mitral and aortic atresia group had higher strain in the basal septal (−13.0, 5.0% versus −3.9, 9.3%, p = 0.003) and mid-septal (−19.4, 4.7% versus −13.2, 6.5%, p = 0.009) segments, and higher strain rates in the mid-septal segment (−1.14, 0.3 per second versus −0.95, 0.4 per second, p = 0.047), smaller left ventricle area (0.18, 0.41 square centimetre versus 2.83, 2.07 square centimetre, p = 0.0001), and shorter wall-to-wall delay (38, 29 milliseconds versus 81, 57 milliseconds, p = 0.02).ConclusionSignificant differences in regional deformation and intraventricular dyssynchrony exist between the mitral and aortic atresia subtype with small left ventricles and the other anatomic subtypes with larger left ventricles after Fontan surgery.

Pre- and Postoperative Quantitation of Right Ventricular Tissue Doppler Velocities in Infants with Hypoplastic Left Heart Syndrome

2006 ◽  
Vol 23 (4) ◽  
pp. 303-307 ◽  
Author(s):  
Douglas Christensen ◽  
Brian Cardis ◽  
William Mahle ◽  
Reginald Lewis ◽  
Jeryl Huckaby ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Hypoplastic Left Heart Syndrome ◽  
Tissue Doppler ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Ventricular Tissue ◽  
Left Heart Syndrome

scholarly journals 1233 Can speckle tracking echocardiography predict outcome in hypoplastic left heart syndrome patients?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N S Borrelli ◽  
G Di Salvo ◽  
J Sabatino ◽  
A Ibrahim ◽  
M Avesani ◽  
...  
Keyword(s):  
Hypoplastic Left Heart Syndrome ◽  
Speckle Tracking ◽  
Area Under The Curve ◽  
Composite Endpoint ◽  
Norwood Procedure ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Systemic Right Ventricle ◽  
Cavopulmonary Anastomosis ◽  
Left Heart Syndrome

Abstract Funding Acknowledgements EACVI Training Grant Introduction Children with Hypoplastic Left Heart Syndrome (HLHS) have a high mortality (up to 95%) and morbidity. Systemic right ventricle (RV) dysfunction plays a key-role in their outcome. Purpose The aim of this study is to evaluate the accuracy of speckle-tracking echocardiographic (STE) assessment of RV deformation and 2D standard echo parameters in predicting death and need for heart transplantation (HT) in HLHS patients. Methods 31 patients with diagnosis of HLHS successfully completed Norwood (n = 29) or comprehensive Norwood stage II (n = 2) at our Institution between 2015 and 2019. Survival at 6 months was 90.32%, survival at 18 months was 85.72%. We studied 29 HLHS patients (17 male). Patients with HLHS variant (n = 2) were excluded. All the studied patients underwent in-hospital interstage stay. Serial echocardiographic assessment was performed in all the included patients (baseline, one month after Norwood, three months after Norwood, one week before bidirectional cavopulmonary anastomosis [BCPA] and two months after BCPA). From the apical view we measured: tricuspid annulus peak systolic excursion (TAPSE), fractional area change (FAC), longitudinal strain (LS) and strain rate (LSR). Results After a mean follow-up of 1.83 ± 1.16 years, 8 out of 29 of the included patients met the composite endpoint of death/HT. At pre-Norwood assessment, there was no statistical difference in echo measurements between survivors and patients who reached the endpoint. In death/HT group TAPSE and LS declined already at one-month after Norwood procedure evaluation. At one-month evaluation, a TAPSE ≤ 5 mm had a good sensitivity for death/HT (85.71%) and a moderate specificity (66.67%), with an area under the curve of 0.789. Always at one-month evaluation, a Δ LS ([{baseline LS – one-month post Norwood LS}/ baseline LS] *100) of 8.7% showed a 100% sensitivity and good specificity (80.95%) for death/HT, with an area under the curve of 0.888. Multivariate analysis showed that one-month-after-Norwood Δ LS was the best predictor of worse outcome (p = 0.02). Conclusions HLHS patients with Δ LS of > 8.7% at one-month after Norwood procedure had a high likelihood of death or HT. These data encourage the routine use of LS to monitor cardiac function in HLHS patients. Abstract 1233 Figure. HLHS LS and trend of TAPSE and LS.

Repair of the tricuspid valve in hypoplastic left heart syndrome

2006 ◽  
Vol 16 (S3) ◽  
pp. 21-26 ◽  
Author(s):  
Richard G. Ohye ◽  
Carlen A. Gomez ◽  
Caren S. Goldberg ◽  
Holly L. Graves ◽  
Eric J. Devaney ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Hypoplastic Left Heart Syndrome ◽  
Volume Overload ◽  
Ventricular Volume ◽  
Norwood Procedure ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Arterial Insufficiency ◽  
Three Stages ◽  
Left Heart Syndrome

The outlook for patients with hypoplastic left heart syndrome has dramatically improved over the past two decades. Universally fatal only 25 years ago, since that time outcomes for staged palliation have shown consistent improvement. Recent reports show that eight to nine patients from every ten can now leave the hospital after the Norwood procedure.1Attrition following the Norwood procedure, nonetheless, remains significant, with from five to fifteen percent of patients dying between the first and second stages of the Norwood sequence.1–4Only three-quarters of the patients undergoing surgery for hypoplastic left heart syndrome survive after five years, even at the centres reporting the best outcomes for the Norwood procedure.1,5In addition to the deaths, some patients are unable to progress through the three stages of reconstruction, and may require cardiac transplantation, or have no options for further therapy. There are many causes for these mortalities and morbidities following the Norwood procedure, including elevated pulmonary vascular resistance, cardiac arrhythmias, coronary arterial insufficiency, right ventricular failure, right ventricular volume overload due to shunt-dependent physiology, and tricuspid valvar regurgitation. Many of these factors are interrelated, and may form feedback loops, which serve to propagate their adverse effects on patients with hypoplastic left heart syndrome.

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