Predictors of retrograde aortic arch obstruction after hybrid palliation of hypoplastic left heart syndrome - PubMed (original) (raw)
Predictors of retrograde aortic arch obstruction after hybrid palliation of hypoplastic left heart syndrome
Matthew J Egan et al. Pediatr Cardiol. 2011 Jan.
Abstract
A potential complication after hybrid stage 1 palliation for hypoplastic left heart syndrome (HLHS) is retrograde aortic arch obstruction (RAAO). This can lead to increased morbidity and unplanned surgical or interventional procedures in the interstage period. This study aimed to identify potential predictors of RAAO by analyzing initial echocardiograms and angiograms before hybrid stage 1 palliation. For this study, 96 patients who underwent hybrid stage 1 palliation between July 2002 and July 2009 were reviewed, 68 of which had standard HLHS and met the inclusion criteria. The initial echocardiogram, hybrid stage 1 angiograms, and follow-up echocardiograms were reviewed. Anatomic and hemodynamic measurements were obtained by both modalities, and comparisons were made between those who developed RAAO and those who did not. Of the 68 patients, 20 (29%) had RAAO. The mean aortic root size was smaller for the patients who had RAAO (3.6 vs 4.4 mm; p = 0.036). The angiographic angle between the aortic isthmus and the patent ductus arteriosus (PDA) was significantly larger in the RAAO group (86° vs 63°; p = 0.008). The retrograde aortic arch velocities were higher in the RAAO group. Patients with RAAO have a smaller aortic root and higher retrograde velocities on initial echocardiogram. Patients with RAAO show a larger angle between the retrograde arch and PDA on angiogram. Because RAAO is an important potential complication after hybrid stage 1 palliation for HLHS, identification of predictors of RAAO may lead to improved care and outcome for patients with RAAO.
Figures
Fig. 1
Aortic annulus and aortic root measurements. This parasternal long-axis view shows measurements of the aortic annulus (A) and aortic root (B)
Fig. 2
Aortic arch measurements. This high parasternal view shows measurements of the ascending aorta (A), proximal transverse aortic arch (B), distal transverse aortic arch (C), and aortic isthmus (D)
Fig. 3
a Patent ductus arteriosus (PDA) stent seen by two-dimensional imaging (left) and color Doppler (right) demonstrating antegrade flow through the PDA stent. There is aliased retrograde flow from the PDA stent into the retrograde aortic arch. b Continuous-wave Doppler analysis of retrograde aortic arch flow in a patient with retrograde aortic arch obstruction (RAAO)
Fig. 4
Lateral angiogram obtained by an injection through a 6-Fr sheath placed in the main pulmonary artery during hybrid stage 1 palliation demonstrating the measurements of the ascending aorta (a), transverse aortic arch (b), aortic isthmus (c), and descending aorta (d)
Fig. 5
Two measurements of the angle between the aortic isthmus orifice and the ductus arteriosus are demonstrated. The angle is obtained by intersecting lines that transect the patent ductus arteriosus (PDA) and the entrance of the aortic isthmus (*). a Angle of 101°. b Angle of 40° between the aortic isthmus and the patent ductus arteriosus (PDA)
Fig. 6
The retrograde aortic arch obstruction (RAAO) group started with slightly higher retrograde aortic arch velocities that increased at a slightly faster rate over time than the group that did not experience RAAO, as demonstrated by the slope of the line
Fig. 7
The patent ductus arteriosus (PDA) velocities increased over time in both groups at similar rates
Similar articles
- The retrograde aortic arch in the hybrid approach to hypoplastic left heart syndrome.
Stoica SC, Philips AB, Egan M, Rodeman R, Chisolm J, Hill S, Cheatham JP, Galantowicz ME. Stoica SC, et al. Ann Thorac Surg. 2009 Dec;88(6):1939-46; discussion 1946-7. doi: 10.1016/j.athoracsur.2009.06.115. Ann Thorac Surg. 2009. PMID: 19932266 - Effects of pulmonary artery banding and retrograde aortic arch obstruction on the hybrid palliation of hypoplastic left heart syndrome.
Baker CE, Corsini C, Cosentino D, Dubini G, Pennati G, Migliavacca F, Hsia TY; Modeling of Congenital Hearts Alliance (MOCHA) Investigators. Baker CE, et al. J Thorac Cardiovasc Surg. 2013 Dec;146(6):1341-8. doi: 10.1016/j.jtcvs.2013.01.038. Epub 2013 Feb 20. J Thorac Cardiovasc Surg. 2013. PMID: 23434295 - Neutrophil/Lymphocyte ratio and association with arch intervention in patients with hypoplastic left heart syndrome undergoing hybrid procedure.
Mitchell E, Cheatham JP, Sisk JM, Nicholson L, Holzer R, Galantowicz M, Cua CL. Mitchell E, et al. Congenit Heart Dis. 2014 Nov-Dec;9(6):543-8. doi: 10.1111/chd.12174. Epub 2014 Apr 4. Congenit Heart Dis. 2014. PMID: 24698017 - Giessen Procedure as Comprehensive Stage II Palliation With Aortic Arch Reconstruction After Hybrid Bilateral Pulmonary Artery Banding and Ductal Stenting for Hypoplastic Left Heart Syndrome.
Yörüker U, Akintürk H. Yörüker U, et al. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2018 Mar;21:19-27. doi: 10.1053/j.pcsu.2017.11.007. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2018. PMID: 29425520 Review. - Postoperative Morbidity and Interstage Hemodynamics Following Stage I Palliation in Patients with Turner Syndrome and Hypoplastic Left Heart Syndrome.
Kikano S, Fuchs S, Vega AC, Kavanaugh-McHugh A, Bichell D, Killen SAS. Kikano S, et al. Pediatr Cardiol. 2024 Feb;45(2):221-227. doi: 10.1007/s00246-023-03395-4. Epub 2023 Dec 28. Pediatr Cardiol. 2024. PMID: 38153546 Review.
Cited by
- Perioperative care of the infant with single ventricle physiology.
Yarlagadda VV, Almodovar MC. Yarlagadda VV, et al. Curr Treat Options Cardiovasc Med. 2011 Oct;13(5):444-55. doi: 10.1007/s11936-011-0134-9. Curr Treat Options Cardiovasc Med. 2011. PMID: 21671164 - Hypoplastic left heart syndrome: current considerations and expectations.
Feinstein JA, Benson DW, Dubin AM, Cohen MS, Maxey DM, Mahle WT, Pahl E, Villafañe J, Bhatt AB, Peng LF, Johnson BA, Marsden AL, Daniels CJ, Rudd NA, Caldarone CA, Mussatto KA, Morales DL, Ivy DD, Gaynor JW, Tweddell JS, Deal BJ, Furck AK, Rosenthal GL, Ohye RG, Ghanayem NS, Cheatham JP, Tworetzky W, Martin GR. Feinstein JA, et al. J Am Coll Cardiol. 2012 Jan 3;59(1 Suppl):S1-42. doi: 10.1016/j.jacc.2011.09.022. J Am Coll Cardiol. 2012. PMID: 22192720 Free PMC article. Review. - Potential Molecular Mechanism of Retrograde Aortic Arch Stenosis in the Hybrid Approach to Hypoplastic Left Heart Syndrome.
Hibino N, Cismowski MJ, Lilly B, McConnell PI, Shinoka T, Cheatham JP, Lucchesi PA, Galantowicz ME, Trask AJ. Hibino N, et al. Ann Thorac Surg. 2015 Sep;100(3):1013-9; discussion 1019-20. doi: 10.1016/j.athoracsur.2015.04.125. Epub 2015 Jul 7. Ann Thorac Surg. 2015. PMID: 26163359 Free PMC article. - Hybrid Palliation for Hypoplastic Left Heart Syndrome: Role of Echocardiography.
Oreto L, Guccione P, Gitto P, Bruno L, Zanai R, Grasso N, Iannace E, Zito C, Carerj S, Agati S. Oreto L, et al. Children (Basel). 2023 Jun 4;10(6):1012. doi: 10.3390/children10061012. Children (Basel). 2023. PMID: 37371244 Free PMC article. Review. - Noninvasive Imaging in Interventional Cardiology: Hypoplastic Left Heart Syndrome.
Bellsham-Revell H. Bellsham-Revell H. Front Cardiovasc Med. 2021 Feb 1;8:637838. doi: 10.3389/fcvm.2021.637838. eCollection 2021. Front Cardiovasc Med. 2021. PMID: 33598485 Free PMC article. Review.
References
- Caldarone CA, Benson LN, Holtby H, Van Arsdell GS. Main pulmonary artery to innominate artery shunt during hybrid palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 2005;130:e1–e2. - PubMed
- Fenstermaker B, Berger GE, Rowland DG, Hayes J, Hill SL, Cheatham JP, Galantowicz M, Cua CL. Interstage echocar-diographic changes in patients undergoing hybrid stage 1 palliation for hypoplastic left heart syndrome. J Am Soc Echocardiogr. 2008;21:1222–1228. - PubMed
- Galantowicz M, Cheatham JP. Lessons learned from the development of a new hybrid strategy for the management of hypoplastic left heart syndrome. Pediatr Cardiol. 2005;26:190–199. - PubMed
- Galantowicz M, Cheatham JP, Phillips A, Cua CL, Hoffman TM, Hill SL, Rodeman R. Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. Ann Thorac Surg. 2008;85:2063–2070. - PubMed
- Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174. - PubMed
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous