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Lanser CNG, van Poecke WHA, Scheffers LE, van den Berg LE, Helbing WA. Stress imaging in patients with a Fontan circulation: A systematic review. Int J Cardiol 2023; 391:131192. [PMID: 37479147 DOI: 10.1016/j.ijcard.2023.131192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION The aims of this study were to provide an overview of the cardiac stress response in Fontan patients and of the use, safety and clinical value of stress imaging in Fontan patients. METHODS Studies evaluating cardiac function using stress imaging in Fontan patients published up until 12 December 2021 were included in this review. RESULTS From 1603 potential studies, 32 studies met the inclusion criteria. In total, stress imaging tests of 728 Fontan patients were included. Cardiac function was most often measured using physical stress (61%), all other studies used dobutamine-induced stress. Stroke volume (SV) increased in most studies (71%), mean SV at rest ranged from 27 mL/m2 to 60 mL/m2 versus 27 mL/m2 to 101 mL/m2 during stress, and increased with an average of 4%. Ejection fraction increased in almost all studies, whereas both end-systolic volume and end-diastolic volume decreased during stress. Higher heart rates were obtained with physical stress (82-180) compared to dobutamine induced stress (73-128). Compared to controls, increases in heartrate and SV were lower and end-diastolic volume decreased abnormally in 75% of reporting studies. No major adverse events were reported. Poorer cardiac stress response was related to decreased exercise capacity and higher risk for long-term (adverse) outcomes in Fontan patients. DISCUSSION Cardiac stress response in Fontan patients differs from healthy subjects, reflected by lower increases in heart rate, diminished preload and decreased cardiac output, especially during higher levels of exercise. Stress imaging is safe, however the added clinical value needs to be investigated in more detail.
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Affiliation(s)
- Charlotte N G Lanser
- Department of Pediatrics, division of Pediatric Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Wessel H A van Poecke
- Department of Pediatrics, division of Pediatric Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Linda E Scheffers
- Department of Pediatrics, division of Pediatric Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Linda E van den Berg
- Department of Orthopedics and Sports Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Willem A Helbing
- Department of Pediatrics, division of Pediatric Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands; Department of Radiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands.
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Prasad D, Romanowicz J, Banka P, Beroukhim R, Ghelani SJ, Emani S, Powell AJ. Cardiac magnetic resonance parameters associated with successful conversion from a single ventricular to a one-and-a-half or biventricular circulation in patients with a hypoplastic right ventricle. J Cardiovasc Magn Reson 2023; 25:51. [PMID: 37759303 PMCID: PMC10537142 DOI: 10.1186/s12968-023-00965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Some patients with pulmonary atresia with an intact ventricular septum (PA/IVS) or a left ventricle dominant atrioventricular canal defect (LDAVC) with a hypoplastic right ventricle (RV) and univentricular (1 V) circulation may be candidates for conversion to either a complete biventricular (2 V) repair or a one-and-a-half ventricle repair (1.5 V). We sought to identify pre-operative cardiovascular magnetic resonance (CMR) findings associated with successful conversion from 1V to 1.5V or 2V circulation. METHODS In this single center retrospective study, subjects with PA/IVS or LDAVC and no conotruncal abnormalities were included if they had a 1 V circulation at the time of CMR followed by a surgical intervention intended to convert them to a 1.5 V or 2 V circulation. Conversion failure was defined as any of the following: (1) oxygen saturation < 90% at the most recent follow-up, (2) conversion back to a 1.5 V or 1 V circulation, or (3) death. RESULTS In the PA/IVS cohort (n = 15, median age 1.32 years), 10 patients underwent surgical conversion to a 1.5 V circulation and 5 to a 2 V circulation. In the attempted 1.5 V group, there were 2 failures, and these cases had a lower RV mass (p = 0.04). In the attempted 2 V group, there was 1 failure, and no CMR parameters were significantly different compared to the successes. Among the successful 2 V group patients, the minimum RV end-diastolic volume (EDV) was 27 ml/m2. In the LDAVC cohort (n = 15, median age 1.0 years), 1 patient underwent surgical conversion to a 1.5 V circulation and 14 patients to a 2 V circulation. In the attempted 1.5 V group, the 1 conversion was a failure and had an RV EDV of 15 ml/m2. In the attempted 2 V group, there were 2 failures, and these cases had a smaller RV:LV stroke volume ratio (p = 0.05) and a lower RV ejection fraction (p = 0.05) compared to the successes. Among the successful 2 V group patients, the minimum RV EDV was 22 ml/m2. CONCLUSIONS We identified multiple CMR parameters associated with successful conversion from 1 V circulation to 1.5 V or 2 V circulation in patients with PA/IVS and LDAVC. This information may improve patient selection for conversion procedures and encourage larger studies to better define the role of CMR.
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Affiliation(s)
- Deepa Prasad
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Banner Children's at Desert Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, USA
| | - Jennifer Romanowicz
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Puja Banka
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Merck & Co., Inc, Rahway, NJ, USA
| | - Rebecca Beroukhim
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Sitaram Emani
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, USA
- Department of Surgery, Harvard Medical School, Boston, USA
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Department of Pediatrics, Harvard Medical School, Boston, USA.
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Konduri A, Sriram C, Mahadin D, Aggarwal S. Exercise Capacity in Patients with Pulmonary Atresia with Intact Ventricular Septum: Does the Type of Surgical Repair Matter? Pediatr Cardiol 2023; 44:556-563. [PMID: 35678826 DOI: 10.1007/s00246-022-02943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
Two standard surgical palliative options for neonates born with pulmonary atresia and intact ventricular septum (PA/IVS) include uni-or biventricular repair. Whenever feasible, the biventricular repair is considered to have better exercise capacity (XC) and outcomes. However, there is a paucity of data comparing objective XC between these two surgical techniques. Our aim was to compare XC, including longitudinal changes in patients with PA/IVS following uni-biventricular repair. We performed a single-center retrospective study of survivors with repaired PA/IVS who underwent comprehensive treadmill cardiopulmonary exercise testing. Initial and latest exercise parameters were compared for longitudinal analysis. Demographic and exercise parameters were collated. Peak oxygen uptake (VO2 in ml/kg/min), an indicator of maximal aerobic capacity, peak heart rate, and other measures of spirometry performed at the same time were collected. Recorded parameters included, (a) Percentage of predicted VO2 (% VO2) normalized for age, weight, height, and gender, (b) % oxygen (O2) pulse, (c) anaerobic threshold (AT), (d) Chronotropic index (CI), (e) % Breathing reserve, (f) Forced vital capacity (FVC), (g) % Forced Expiratory volume in 1 s (FEV1), (h) Maximum voluntary ventilation (MVV), and (i) VE/VCO2. Appropriate statistical tests were performed, and a p value < 0.05 was considered significant. A total of 35 patients (43% male, 57% univentricular repair) were included, with a mean (SD) age of 20.1(7.5) years. Patients with univentricular palliation demonstrated significantly impaired peak heart rate, chronotropic index (0.50 ± 0.2 vs. 0.90 ± 0.1, p = 0.02), VE/VCO2 (35.4 ± 5.0 vs. 30.2 ± 2.8, p = 0.001), and %FVC (78.3 ± 8.3 vs. 88.6 ± 15.1, p = 0.02). There was a trend towards reduction in % VO2 in the Fontan patients though it was statistically similar between the groups (68.4 ± 21.4 vs. 81.2 ± 18.9, p = 0.07). Longitudinal data were available for 11 patients in each group, and there was no longitudinal decline in their exercise parameters over similar intermediate follow-up duration [6.8 (UV) vs. 5.3 (BV) years]. We conclude that young survivors with PA/IVS with prior univentricular palliation demonstrated an objective impairment in their chronotropic parameters compared with the biventricular repair. However, this did not translate into a significant difference in their exercise capacity. There was no longitudinal decline in exercise capacity or other parameters over intermediate follow-up.
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Affiliation(s)
- Anusha Konduri
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA.
| | - Chenni Sriram
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA
| | - Deemah Mahadin
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA
| | - Sanjeev Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA
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Neonatal Pulmonary Atresia With Intact Ventricular Septum-8-Year Surgical Experience at One Center. J Surg Res 2020; 251:38-46. [PMID: 32113036 DOI: 10.1016/j.jss.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/23/2020] [Accepted: 01/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgical treatment of pulmonary atresia with intact ventricular septum (PA/IVS) in neonates is challenging because of the broad variations of right ventricular (RV) malformations. In this retrospective study, we summarized our 8-y experience in surgical management for neonatal PA/IVS patients. METHODS Thirty-four neonates with PA/IVS between July 1, 2006 and June 30, 2014, were reviewed. Patients were categorized into three groups: mild, moderate, and severe RV hypoplasia according to RV morphology and development. Patients were on regular follow-up for at least 5 y. Overall survival, complications, reinterventions, risk factors for mortality, and health status were evaluated. RESULTS 21 patients (61.8%) were treated with biventricular repair, eight patients (23.5%) with Fontan procedure, and one patient (2.9%) with bidirectional Glenn procedure. There were four postprocedural mortalities and one late death. The 5-y survival rates after final surgical repair for mild, moderate, and severe RV hypoplasia groups were 100%, 100%, and 88.9%, respectively. The reintervention rates were 0% (0/4), 21.4% (3/14), and 55.6% (5/9) for the subgroups, respectively. At the latest follow-up, most patients had a status characterized as New York Heart Association class I (88.9%, 24/27). CONCLUSIONS Surgical management for PA/IVS in neonates should be individualized. Favorable early and long-term outcomes can be achieved in neonatal PA/IVS patients by individualized surgical strategies, regardless of the degree of RV hypoplasia. In spite of potential RV catch-up development, the degree of RV hypoplasia is a factor of paramount importance to assess PA/IVS in neonates.
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He X, Gao B, Shi G, Chen H, Du X, Xu Z, Liu J, Zhu Z, Zheng J. Surgical strategy and outcomes for the delayed diagnosis of pulmonary atresia with intact ventricular septum. J Cardiol 2018; 72:50-55. [PMID: 29358023 DOI: 10.1016/j.jjcc.2017.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/12/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the present study, we summarize the experiences and evaluate clinical outcomes for the delayed diagnosis of pulmonary atresia with intact ventricular septum (PAIVS) patients when undergoing an initial visit and diagnosis in our heart center. METHODS Fifty-eight cases of delayed diagnosis of PAIVS in patients aged more than 6 months between January 2006 and June 2016 were reviewed in our hospital. The median age at initial diagnosis was 12.2 months (range, 6.1-79.6 months). Forty-five cases eventually reached definitive repair. Survival, risk factors for death, and clinical status after definitive repair were assessed. RESULTS Among patients who completed definitive repair, the Fontan procedure was performed in a large proportion of older PAIVS children (42.2%, 19/45), while only a few patients received biventricular repair (22.2%, 10/45). The medium-term (10-year) survival rates of biventricular repair, 1.5-ventricular repair, and univentricular palliation were 100.0%, 93.3%, and 81.2%, respectively. At the latest follow-up, most patients had a good clinical status after definitive repairs, with a low re-operation rate. CONCLUSIONS A large proportion of the delayed diagnosis of PAIVS patients had to receive univentricular palliation because of limited potential for right ventricular growth. However, optimal definitive repairs could also have been achieved in these patients with a low mortality rate.
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Affiliation(s)
- Xiaomin He
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Botao Gao
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guocheng Shi
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiwen Chen
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinwei Du
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiwei Xu
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinfen Liu
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongqun Zhu
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jinghao Zheng
- Department of Pediatric Cardiothoracic Surgery, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Zheng J, Gao B, Zhu Z, Shi G, Xu Z, Liu J, He X. Surgical results for pulmonary atresia with intact ventricular septum: a single-centre 15-year experience and medium-term follow-up. Eur J Cardiothorac Surg 2016; 50:1083-1088. [DOI: 10.1093/ejcts/ezw226] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/12/2016] [Accepted: 05/26/2016] [Indexed: 11/13/2022] Open
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Li FF, Du XL, Chen S. Biventricular repair versus uni-ventricular repair for pulmonary atresia with intact ventrical septum: A systematic review. ACTA ACUST UNITED AC 2015; 35:656-661. [PMID: 26489617 DOI: 10.1007/s11596-015-1485-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/14/2015] [Indexed: 10/22/2022]
Abstract
The management of pulmonary atresia with intact ventricular septum (PA/IVS) remains controversial. The goal of separating systematic and pulmonary circulation can be achieved by biventricular or uni-ventricular (Fontan or one and a half ventricle repair) strategies. Although outcomes have been improved, these surgical procedures are still associated with high mortality and morbidity. An optimal strategy for definitive repair has yet to be defined. We searched databases for genetically randomized controlled trials (RCTs) comparing biventricular with uni-ventricular repair for patient with PA/IVS. Data extraction and quality assessment were performed following the guidelines of the Cochrane Collaboration. Primary outcome measures were overall survival, and secondary criteria included exercise function, arrhythmia-free survival and treatment-related mortality. A total number of 669 primary citations were screened for relevant studies. Detailed analysis revealed that no RCTs were found to adequately address the research question and no systematic meta-analysis would have been carried out. Nevertheless, several retrospective analyses and case series addressed the question of finding right balance between biventricular and uni-ventricular repair for patient with PA/IVS. In this review, we will discuss the currently available data.
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Affiliation(s)
- Fei-Fei Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xin-Ling Du
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shu Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Davies RR, Pizarro C. Decision-Making for Surgery in the Management of Patients with Univentricular Heart. Front Pediatr 2015; 3:61. [PMID: 26284226 PMCID: PMC4515559 DOI: 10.3389/fped.2015.00061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/21/2015] [Indexed: 12/24/2022] Open
Abstract
A series of technical refinements over the past 30 years, in combination with advances in perioperative management, have resulted in dramatic improvements in the survival of patients with univentricular heart. While the goal of single-ventricle palliation remains unchanged - normalization of the pressure and volume loads on the systemic ventricle, the strategies to achieve that goal have become more diverse. Optimal palliation relies on a thorough understanding of the changing physiology over the first years of life and the risks and consequences of each palliative strategy. This review describes how to optimize surgical decision-making in univentricular patients based on a current understanding of anatomy, physiology, and surgical palliation.
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Affiliation(s)
- Ryan Robert Davies
- Nemours Cardiac Center, A. I. duPont Hospital for Children , Wilmington, DE , USA ; Thomas Jefferson University , Philadelphia, PA , USA
| | - Christian Pizarro
- Nemours Cardiac Center, A. I. duPont Hospital for Children , Wilmington, DE , USA ; Thomas Jefferson University , Philadelphia, PA , USA
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Schneider AW, Blom NA, Bruggemans EF, Hazekamp MG. More Than 25 Years of Experience in Managing Pulmonary Atresia With Intact Ventricular Septum. Ann Thorac Surg 2014; 98:1680-6. [DOI: 10.1016/j.athoracsur.2014.05.085] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 12/01/2022]
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Atresia pulmonar con septo íntegro. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bossers SSM, Helbing WA, Duppen N, Kuipers IM, Schokking M, Hazekamp MG, Bogers AJJC, Ten Harkel ADJ, Takken T. Exercise capacity in children after total cavopulmonary connection: lateral tunnel versus extracardiac conduit technique. J Thorac Cardiovasc Surg 2014; 148:1490-7. [PMID: 24521957 DOI: 10.1016/j.jtcvs.2013.12.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/20/2013] [Accepted: 12/24/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In patients with univentricular heart disease, the total cavopulmonary connection (TCPC) is the preferred treatment. TCPC can be performed using the intra-atrial lateral tunnel (ILT) or extracardiac conduit (ECC) technique. The purpose of the present study was to evaluate exercise capacity in contemporary TCPC patients and compare the results between the 2 techniques. METHODS A total of 101 TCPC patients (ILT, n=42; ECC, n=59; age, 12.2±2.6 years; age at TCPC completion, 3.2±1.1 years) underwent cardiopulmonary exercise testing. The patients were recruited prospectively from 5 tertiary referral centers. RESULTS For the entire group, the mean peak oxygen uptake was 74%±14%, peak heart rate was 90%±8%, peak workload was 62%±13%, and slope of ventilation versus carbon dioxide elimination (VE/VCO2 slope) was 127%±30% of the predicted value. For the ILT and ECC groups, patient age, age at TCPC completion, body surface area, peak workload, and peak heart rate were comparable. The percentage of predicted peak oxygen uptake was lower in the ILT group (70%±12% vs 77%±15%; P=.040), and the percentage of predicted VE/VCO2 slope was greater in the ILT group (123%±36% vs 108%±14%; P=.015). In a subgroup analysis that excluded ILT patients with baffle leak, these differences were not statistically significant. CONCLUSIONS Common exercise parameters were impaired in contemporary Fontan patients. Chronotropic incompetence was uncommon. The peak oxygen uptake and VE/VCO2 slope were less favorable in ILT patients, likely related to baffle leaks in some ILT patients. These results have shown that a reduced exercise capacity in Fontan patients remains an important issue in contemporary cohorts. The ECC had a more favorable exercise outcome at medium-term follow-up.
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Affiliation(s)
- Sjoerd S M Bossers
- Department of Pediatric Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Willem A Helbing
- Department of Pediatric Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Nienke Duppen
- Department of Pediatric Cardiology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Irene M Kuipers
- Department of Pediatric Cardiology, Academic Medical Centre - Emma Children's Hospital, Amsterdam, The Netherlands
| | - Michiel Schokking
- Department of Pediatric Cardiology, Radboud University Medical Centre - Radboud University Medical Centre Children's Hospital, Nijmegen, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Centre - Willem-Alexander Child and Youth Centre, Leiden, The Netherlands
| | - Tim Takken
- Child Development and Exercise Centre, Department of Pediatric Cardiology, University Medical Centre Utrecht - Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Uribe S, Bächler P, Valverde I, Crelier GR, Beerbaum P, Tejos C, Irarrazaval P. Hemodynamic assessment in patients with one-and-a-half ventricle repair revealed by four-dimensional flow magnetic resonance imaging. Pediatr Cardiol 2013; 34:447-51. [PMID: 22447380 DOI: 10.1007/s00246-012-0288-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
Abstract
We report hemodynamic findings in two patients with pulmonary atresia and intact ventricular septum (PAIVS) after "one-and-a-half ventricle repair" and placement of a bidirectional Glenn shunt using four-dimensional (4D) flow magnetic resonance imaging. Quantification of flow and analysis of flow patterns revealed the hemodynamic "battle" between the right ventricle (RV) and the Glenn shunt. Moreover, with a novel approach we calculated during Glenn anastomosis the flow distribution from the superior vena cava (SVC) to the pulmonary arteries. Our results showed a highly asymmetric flow distribution, with most of the flow from the SVC toward the RV and not to the lungs. The evidence provided by 4D flow demonstrates poor efficiency of this system and suggests that both patients might benefit from adding an artificial pulmonary valve to avoid right heart failure.
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Affiliation(s)
- Sergio Uribe
- Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Karamlou T, Poynter JA, Walters HL, Rhodes J, Bondarenko I, Pasquali SK, Fuller SM, Lambert LM, Blackstone EH, Jacobs ML, Duncan K, Caldarone CA, Williams WG, McCrindle BW. Long-term functional health status and exercise test variables for patients with pulmonary atresia with intact ventricular septum: a Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg 2013; 145:1018-1027.e3. [PMID: 23374986 DOI: 10.1016/j.jtcvs.2012.11.092] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 10/18/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND A bias favoring biventricular (BV) repair exists regarding choice of repair pathway for patients with pulmonary atresia with intact ventricular septum (PAIVS). We sought to determine the implications of moving borderline candidates down a BV route in terms of late functional health status (FHS) and exercise capacity (EC). METHODS Between 1987 and 1997, 448 neonates with PAIVS were enrolled in a multi-institutional study. Late EC and FHS were assessed following repair (mean 14 years) using standardized exercise testing and 3 validated FHS instruments. Relationships between FHS, EC, morphology, and 3 end states (ie, BV, univentricular [UV], or 1.5-ventricle repair [1.5V]) were evaluated. RESULTS One hundred two of 271 end state survivors participated (63 BV, 25 UV, and 14 1.5V). Participants had lower FHS scores in domains of physical functioning (P < .001) compared with age- and sex-matched normal controls, but scored significantly higher in nearly all psychosocial domains. EC was higher in 1.5V-repair patients (P = .02), whereas discrete FHS measures were higher in BV-repair patients. Peak oxygen consumption was low across all groups, and was positively correlated with larger initial tricuspid valve z-score (P < .001), with an enhanced effect within the BV-repair group. CONCLUSIONS Late patient-perceived physical FHS and measured EC are reduced, regardless of PAIVS repair pathway, with an important dichotomy whereby patients with PAIVS believe they are doing well despite important physical impediments. For those with smaller initial tricuspid valve z-score, achievement of survival with BV repair may be at a cost of late deficits in exercise capacity, emphasizing that better outcomes may be achieved for borderline patients with a 1.5V- or UV-repair strategy.
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Affiliation(s)
- Tara Karamlou
- Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California, San Francisco, San Francisco, Calif.
| | - Jeffrey A Poynter
- Division of Cardiovascular Surgery, The Hospital For Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Henry L Walters
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Detroit, Mich
| | | | - Igor Bondarenko
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Detroit, Mich
| | - Sara K Pasquali
- Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Mich
| | - Stephanie M Fuller
- Division of Cardiovascular Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Linda M Lambert
- Department of Pediatric Cardiovascular Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Eugene H Blackstone
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marshall L Jacobs
- Department of Pediatric and Congenital Heart Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kim Duncan
- Division of Cardiothoracic Surgery, Children's Hospital and Medical Center, Omaha, Neb
| | - Christopher A Caldarone
- Division of Cardiovascular Surgery, The Hospital For Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - William G Williams
- Division of Cardiovascular Surgery, The Hospital For Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Sharma V, Burkhart HM, Cetta F, Hagler DJ, Phillips SD, Dearani JA. Fontan Conversion to One and One Half Ventricle Repair. Ann Thorac Surg 2012; 94:1269-74; discussion 1274. [DOI: 10.1016/j.athoracsur.2012.04.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 04/12/2012] [Accepted: 04/16/2012] [Indexed: 11/15/2022]
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Romeih S, Groenink M, van der Plas MN, Spijkerboer AM, Hazekamp MG, Luijnenburg S, Mulder BJ, Blom NA. Effect of age on exercise capacity and cardiac reserve in patients with pulmonary atresia with intact ventricular septum after biventricular repair. Eur J Cardiothorac Surg 2012; 42:50-5. [DOI: 10.1093/ejcts/ezr267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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