Evolution of Ventricular Energetics in the Different Stages of Palliation of Hypoplastic Left Heart Syndrome: A Retrospective Clinical Study

Abstract

Hyperplastic left heart syndrome (HLHS) patients are palliated by creating a Fontan-type circulation passing from different surgical stages. The aim of this work is to describe the evolution of ventricular energetics parameters in HLHS patients during the different stages of palliation including the hybrid, the Norwood, the bidirectional Glenn (BDG), and the Fontan procedures. We conducted a retrospective clinical study enrolling all HLHS patients surgically treated with hybrid procedure and/or Norwood and/or BDG and/or Fontan operation from 2011 to 2016 collecting echocardiographic and hemodynamic data. Measured data were used to calculate energetic variables such as ventricular elastances, external and internal work, ventriculo-arterial coupling and cardiac mechanical efficiency. From 2010 to 2016, a total of 29 HLHS patients undergoing cardiac catheterization after hybrid (n = 7) or Norwood (n = 6) or Glenn (n = 8) or Fontan (n = 8) procedure were retrospectively enrolled. Ventricular volumes were significantly higher in the Norwood circulation than in the hybrid circulation (p = 0.03) with a progressive decrement from the first stage to the Fontan completion. Ventricular elastances were lower in the Norwood circulation than in the hybrid circulation and progressively increased passing from the first stage to the Fontan completion. The arterial elastance and Rtot increased in the Fontan circulation. The ventricular work progressively increased. Finally, the ventricular efficiency improves passing from the first to the last stage of palliation. The use of ventricular energetic parameters could lead to a more complete evaluation of such complex patients to better understand their adaptation to different pathophysiological conditions.

Loss of Ventricular Function After Bidirectional Cavopulmonary Connection: Who Is at Risk?

“…The BDCPC is thought to have the least morbidity and mortality and is generally associated with a short cardiopulmonary bypass time [9]. However, the BDCPC changes preload parameters of the SV and could impact ventricular function [10] thereby impacting candidacy for Fontan operation and long-term outcome [11]. Sustaining good ventricular function is one of the main goals of management of patients with a functionally SV heart [12,13].…”

The Evolution of Therapeutic Strategies: Niche Apportionment for Hybrid Palliation

“…Other groups did not find significant differences in systemic ventricular function [45,46] but indicated that impaired systolic right ventricular strain and strain rate values may be indicative of a subclinical functional decline that becomes relevant during follow-up [46]. After aortic arch reconstruction, patients with initial hybrid palliation also showed higher arterial resistance but better Nassar [38] Pulmonary artery stent graft baffle instead of arch reconstruction at comprehensive stage II DeCampli [39] arterioventricular coupling compared with primary Norwood patients [47]. Bilateral pulmonary artery banding shows a similar diastolic pulmonary runoff than that seen with modified Blalock-Taussig shunts [42].…”