Abstract 4559: Cardiac Magnetic Resonance Imaging Versus Cardiac Catheterisation: An Analysis of Operative Outcomes in Children with Hypoplastic Left Heart Syndrome Undergoing Bidirectional Cavopulmonary Connection
Introduction: Recent evidence has suggested that haemodynamic information is not essential in preoperative assessment of children with Hypoplastic Left Heart Syndrome (HLHS) undergoing Bidirectional Cavopulmonary Connection (BCPC). For this reason our unit moved from echocardiography and cardiac catheterisation to echocardiography and cardiac Magnetic Resonance Imaging (MRI) as the routine preoperative assessment of this patient group in 2006. Through this retrospective study we aimed to review the consequences of this change focusing in particular on the perioperative course.\
Methods: Children with HLHS who underwent BCPC between January 2004 and December 2007 were identified from the cardiac surgical database. Data were collected regarding preoperative findings and postoperative course.
Results: 40 patients were identified- catheterisation (n=21), MRI (n=19). Catheterisation patients were older at BCPC (114.9 +/− 22.7 vs. 95.4 +/− 11 days; p value 0.002), with no other differences in baseline data. All patients had normal or mildly reduced ventricular systolic function. The majority had no more than mild tricuspid valve regurgitation. Two patients required CPR during catheterisation; with no adverse events during MRI. Anatomical information obtained in both groups correlated well with surgical findings. Perioperative course was similar including cardiopulmonary bypass time, ventilation time, inotrope score, CVP and ICU stay. One patient in the MRI group required LVAD support postoperatively. In the catheter group two patients required further surgery and three catheter intervention within one month of BCPC. One patient required further surgery in the MRI group. Oxygen saturations measured in PICU were higher in the catheterisation group (80% +/− 5 vs 75% +/− 5; p value 0.001) with no difference at discharge. Hospital length of stay was similar.
Conclusions: We have demonstrated that postoperative course and outcomes are similar in patients with HLHS who had cardiac MRI or cardiac catheterisation as their pre-BCPC investigation. Additionally the complementary data provided by echocardiography and cardiac MRI safely provides sufficient anatomic and functional information on which to plan the BCPC.