Abstract 20412: Novel Quantification of Right Ventricular Physiology in Infants with Hypoplastic Left Heart Syndrome s/p Norwood palliation with Right Ventricle to Pulmonary Artery Conduit
Introduction: The balance of systemic vs. pulmonary blood flow is critical for patients with single ventricle physiology. For infants with Hypoplastic Left Heart Syndrome (HLHS) after Norwood palliation with a RV-PA conduit, the ratio of the duration of systolic flow (DSF) in the conduit and neo-aorta should provide information about the relative resistance into the pulmonary and systemic beds.
Methods: The surgical database of Children's Hospital of Wisconsin was queried for all patients s/p Norwood operation with RV-PA conduit from 10/2003 to 1/2010 not enrolled in multi-institutional trials. The DSF was measured in the RV-PA conduit and the ascending neo-aorta (Ao) by spectral Doppler within 30 days of surgery by transthoracic echo, and the ratio (DSF RV-PA conduit/DSF Ao) was then compared to clinical outcomes using Student's T-test.
Results: During the study period 39 patients underwent Norwood palliation with a RV-PA conduit. DSF ratios are summarized for various clinical outcomes in table I, with a significant ratio decrease correlating with prolonged duration of mechanical ventilation, inotropic support, and hospital stay. There were no significant differences in the ratio compared to indices of interval growth, chest tube output, or severe adverse outcome. Preop characteristics were not different between any of the groups.
Conclusions:. Decrease in the DSF RV-PA/DSF Ao ratio appears to predict less favorable clinical outcome early after Norwood palliation for infants with HLHS. This new non-invasive measure should predict single ventricle physiology and may help predict clinical needs/outcomes in this unique patient population.
- © 2010 by American Heart Association, Inc.