Garick D Hill1, Peter C Frommelt2, Jessica Stelter2, M Jay Campbell3, Meryl S Cohen4, Rami Kharouf5, Wyman W Lai6, Jami C Levine7, Jimmy C Lu8, Shaji C Menon9, Timothy C Slesnick10, Pierre C Wong11, David E Saudek2. 1. Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: ghill@chw.org. 2. Medical College of Wisconsin, Milwaukee, Wisconsin. 3. Duke University, Durham, North Carolina. 4. The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 5. Alfred I. DuPont Hospital for Children, Wilmington, Delaware. 6. Columbia University Medical Center, New York, New York. 7. Boston Children's Hospital, Boston, Massachusetts. 8. University of Michigan, Ann Arbor, Michigan. 9. University of Utah, Salt Lake City, Utah. 10. Emory University School of Medicine, Atlanta, Georgia. 11. Children's Hospital Los Angeles, Los Angeles, California.
Abstract
BACKGROUND: The Single Ventricle Reconstruction trial demonstrated a transplantation-free survival advantage at 12-month follow-up for patients with right ventricle-pulmonary artery shunts (RVPAS) with the Norwood procedure compared with modified Blalock-Taussig shunts but similar survival and decreased global right ventricular (RV) function on longer term follow-up. The impact of the required ventriculotomy for the RVPAS remains unknown. The aim of this study was to compare echocardiography-derived RV deformation indices after stage 2 procedures in survivors with single RV anomalies enrolled in the Single Ventricle Reconstruction trial. METHODS:Global and regional RV systolic longitudinal and circumferential strain and strain rate, ejection fraction, and short-axis percentage fractional area change were all derived by speckle-tracking echocardiography from protocol echocardiograms obtained at 14.3 ± 1.2 months. Student t tests or Wilcoxon rank sum tests were used to compare groups. RESULTS: The cohort included 275 subjects (129 in the modified Blalock-Taussig shunt group and 146 in the RVPAS group). Longitudinal deformation could be quantified in 214 subjects (78%) and circumferential measures in 182 subjects (66%). RV ejection fraction and percentage fractional area change did not differ between groups. There were no significant differences between groups for global or regional longitudinal deformation. Circumferential indices showed abnormalities in deformation in the RVPAS group, with decreased global circumferential strain (P = .05), strain rate (P = .09), and anterior regional strain rate (P = .07) that approached statistical significance. CONCLUSIONS:RV myocardial deformation at 14 months, after stage 2 procedures, was not significantly altered by the type of initial shunt placed. However, abnormal trends were appreciated in circumferential deformation for the RVPAS group in the area of ventriculotomy that may represent early myocardial dysfunction. These data provide a basis for longer term RV deformation assessment in survivors after Norwood procedures.
RCT Entities:
BACKGROUND: The Single Ventricle Reconstruction trial demonstrated a transplantation-free survival advantage at 12-month follow-up for patients with right ventricle-pulmonary artery shunts (RVPAS) with the Norwood procedure compared with modified Blalock-Taussig shunts but similar survival and decreased global right ventricular (RV) function on longer term follow-up. The impact of the required ventriculotomy for the RVPAS remains unknown. The aim of this study was to compare echocardiography-derived RV deformation indices after stage 2 procedures in survivors with single RV anomalies enrolled in the Single Ventricle Reconstruction trial. METHODS: Global and regional RV systolic longitudinal and circumferential strain and strain rate, ejection fraction, and short-axis percentage fractional area change were all derived by speckle-tracking echocardiography from protocol echocardiograms obtained at 14.3 ± 1.2 months. Student t tests or Wilcoxon rank sum tests were used to compare groups. RESULTS: The cohort included 275 subjects (129 in the modified Blalock-Taussig shunt group and 146 in the RVPAS group). Longitudinal deformation could be quantified in 214 subjects (78%) and circumferential measures in 182 subjects (66%). RV ejection fraction and percentage fractional area change did not differ between groups. There were no significant differences between groups for global or regional longitudinal deformation. Circumferential indices showed abnormalities in deformation in the RVPAS group, with decreased global circumferential strain (P = .05), strain rate (P = .09), and anterior regional strain rate (P = .07) that approached statistical significance. CONCLUSIONS: RV myocardial deformation at 14 months, after stage 2 procedures, was not significantly altered by the type of initial shunt placed. However, abnormal trends were appreciated in circumferential deformation for the RVPAS group in the area of ventriculotomy that may represent early myocardial dysfunction. These data provide a basis for longer term RV deformation assessment in survivors after Norwood procedures.
Authors: Laurens P Koopman; Cameron Slorach; Cedric Manlhiot; Brian W McCrindle; Edgar T Jaeggi; Luc Mertens; Mark K Friedberg Journal: J Am Soc Echocardiogr Date: 2010-11-20 Impact factor: 5.251
Authors: Shaji C Menon; L Luann Minich; T Charles Casper; Michael D Puchalski; John A Hawkins; Lloyd Y Tani Journal: J Am Soc Echocardiogr Date: 2011-06-15 Impact factor: 5.251
Authors: Eric M Graham; Sinai C Zyblewski; Jacob W Phillips; Girish S Shirali; Scott M Bradley; Geoffery A Forbus; Varsha M Bandisode; Andrew M Atz Journal: Ann Thorac Surg Date: 2010-07 Impact factor: 4.330
Authors: Peter C Frommelt; Lin T Guey; L LuAnn Minich; Majeed Bhat; Tim J Bradley; Steve D Colan; Greg Ensing; Jessica Gorentz; Haleh Heydarian; J Blaine John; Wyman W Lai; Jami C Levine; William T Mahle; Stephen G Miller; Richard G Ohye; Gail D Pearson; Girish S Shirali; Pierre C Wong; Meryl S Cohen Journal: Circulation Date: 2012-04-21 Impact factor: 29.690
Authors: William T Mahle; Chenwei Hu; Felicia Trachtenberg; JonDavid Menteer; Steven J Kindel; Anne I Dipchand; Marc E Richmond; Kevin P Daly; Heather T Henderson; Kimberly Y Lin; Michael McCulloch; Ashwin K Lal; Kurt R Schumacher; Jeffrey P Jacobs; Andrew M Atz; Chet R Villa; Kristin M Burns; Jane W Newburger Journal: J Heart Lung Transplant Date: 2018-02-16 Impact factor: 10.247
Authors: Peter C Frommelt; Chenwei Hu; Felicia Trachtenberg; Jeanne Marie Baffa; Richard J Boruta; Shahryar Chowdhury; James F Cnota; Andreea Dragulescu; Jami C Levine; Jimmy Lu; Laura Mercer-Rosa; Thomas A Miller; Amee Shah; Timothy C Slesnick; Gary Stapleton; Jessica Stelter; Pierre Wong; Jane W Newburger Journal: Circ Cardiovasc Imaging Date: 2019-02 Impact factor: 7.792
Authors: Miriam Michel; Jana Logoteta; Andreas Entenmann; Jan Hinnerk Hansen; Inga Voges; Hans-Heiner Kramer; Colin Petko Journal: Pediatr Cardiol Date: 2016-06-02 Impact factor: 1.655
Authors: Alan P Wang; Angela M Kelle; Meredith Hyun; Chelsea L Reece; Phillip M Young; Patrick W O'Leary; M Yasir Qureshi Journal: Pediatr Cardiol Date: 2020-10-26 Impact factor: 1.655