Geometry and growth of the reconstructed aorta in patients with hypoplastic left heart syndrome and variants

Haller, Christoph; Chetan, Devin; Saedi, Arezou; Parker, Rachel; Arsdell, Glen S. Van; Honjo, Osami

doi:10.1016/j.jtcvs.2017.02.011

Cited by 15 publications

(12 citation statements)

References 28 publications

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“…In particular, the correlation between the geometrical morphology of the aortic arch and the incidence of re-interventions was investigated in relationship to the presence of gothic aortic arch ( 28 – 31 ). Despite the presence of gothic aortic arch was observed in the pre-operative CT scan investigation in 2/13 (= 15.4%) patients requiring re-intervention vs. only 2/38 (= 5.3%) patients who didn't require re-intervention, the difference didn't reach statistical difference at the T -test ( P = 0.12).…”

Section: Resultsmentioning

confidence: 99%

“…Recurrent obstruction in the correspondence of the aortic arch and/or isthmus, requiring either interventional procedures (balloon dilatation/stent) or surgery, is the most frequently reported complication, with an extremely variable incidence reported from 2 to 38%. The recurrent obstruction seems to be correlated with the surgical technique utilized, with the lowest incidence of re-intervention reported with ascending sliding arch aortoplasty and/or aortic arch advancement technique (2–3%), in comparison with the patch enlargement technique (18–38%), occasionally correlated with the patch material used ( 22 , 29 – 31 , 37 , 45 – 51 , 53 ).…”

Section: Discussionmentioning

confidence: 96%

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Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair?

et al. 2018

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Introduction: We reviewed our experience with decellularized porcine small intestine sub-mucosa (DPSIS) patch, recently introduced for congenital heart defects.Materials and Methods: Between 10/2011 and 04/2016 a DPSIS patch was used in 51 patients, median age 1.1 months (5 days to 14.5 years), for aortic arch reconstruction (45/51 = 88.2%) or aortic coarctation repair (6/51 = 11.8%). All medical records were retrospectively reviewed, with primary endpoints interventional procedure (balloon dilatation) or surgery (DPSIS patch replacement) due to patch-related complications.Results: In a median follow-up time of 1.5 ± 1.1 years (0.6–2.3years) in 13/51 patients (25.5%) a re-intervention, percutaneous interventional procedure (5/51 = 9.8%) or re-operation (8/51 = 15.7%) was required because of obstruction in the correspondence of the DPSIS patch used to enlarge the aortic arch/isthmus, with median max velocity flow at Doppler interrogation of 4.0 ± 0.51 m/s. Two patients required surgery after failed interventional cardiology. The mean interval between DPSIS patch implantation and re-intervention (percutaneous procedure or re-operation) was 6 months (1–17 months). While there were 3 hospital deaths (3/51 = 5.9%) not related to the patch implantation, no early or late mortality occurred for the subsequent procedure required for DPSIS patch interventional cardiology or surgery. The median max velocity flow at Doppler interrogation through the aortic arch/isthmus for the patients who did not require interventional procedure or surgery was 1.7 ± 0.57 m/s.Conclusions: High incidence of re-interventions with DPSIS patch for aortic arch and/or coarctation forced us to use alternative materials (homografts and decellularized gluteraldehyde preserved bovine pericardial matrix).

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair?

et al. 2018

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“…In this issue of The Journal, Haller and colleagues [2] report on their experience with aortic arch reconstruction in hypoplastic left heart syndrome and variants (HLHS) utilizing the interdigitating technique. The principles to this reconstruction have been previously reported [3] but, in brief, involve complete mobilization of the arch vessels and proximal descending aorta in an effort to eliminate any tension.…”

Section: Life Without Geometry Is Pointless -Anonymousmentioning

confidence: 99%

The importance of arch geometry after Norwood reconstruction

Burkhart

Thompson

Mir

2017

The Journal of Thoracic and Cardiovascular Surgery

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“…In patients with hypoplastic left heart syndrome (HLHS), formation of a "neo-aorta" is an integral part of the Norwood procedure (Figure 1) that includes creation of an anastomosis of the native aorta to the former pulmonary trunk and reconstruction of the ascending aorta and transverse arch using a porcine pericardial graft (1,2). This sophisticated aortic surgery leads to an abnormal neoaortic twist that potentially leads to abnormal fluid dynamics and increased ventricular afterload with subsequent myocardial hypertrophy and impaired ventricular function in the long run (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Abnormal torsion and helical flow patterns of the neo-aorta in hypoplastic left heart syndrome assessed with 4D-flow MRI

Gabbert¹,

Trotz²,

Kheradvar³

et al. 2021

Cardiovasc Diagn Ther

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Background: The Norwood procedure is the first stage of correction for patients with hypoplastic left heart syndrome (HLHS) and may lead to an abnormal neoaortic anatomy. We prospectively studied the neoaorta's fluid dynamics and the abnormal twist of the neoaorta by MRI examinations of HLHS patients in Fontan circulation. This study for the first time investigates the hypothesis that the neoaorta twist is associated with increased helical flow patterns, which may lead to an increased workload for the systemic right ventricle (RV) and ultimately to RV hypertrophy.Methods: A group of forty-two HLHS patients with a median age of 4.9 (2.9-17.0) years, at NYHA I was studied along with a control group of eleven subjects with healthy hearts and a median age of 12.1 (4.0-41.6).All subjects underwent MRI of the thoracic aorta including ECG-gated 2D balanced SSFP cine for an axial slice stack and 4D-flow MRI for a sagittal volume slab covering the thoracic aorta. The twist of the neoaortic arch was quantified by the effective geometric torsion, defined as the product of curvature and geometric torsion. Fluid dynamics and geometry in the neoaorta, including the flow helicity index, were evaluated using an in-house analysis software (MeVisLab-based). Myocardial mass of the systemic ventricle at end-diastole was estimated by planimetry of the short-axis stack.Results: Compared to the control group, the neoaorta in the HLHS patients shows an increased twist (P=0.04) and higher peak helicity density (P=0.03). The maximum helicity density was correlated with maximum effective torsion of the ascending neoaorta (P<0.001). The degree of maximum twist correlated with the increase in RV myocardial mass (P<0.01). Conclusions:This study shows that the abnormal twist of the neoaortic arch in HLHS patients is associated with abnormal helical flow patterns, which may contribute to increased RV afterload and may adversely affect the systemic RV by stimulation of myocardial hypertrophy. These findings suggest that further improvements of surgical aortic reconstruction, guided by insights from 4D-flow MRI, could lead to better neoaortic fluid dynamics in patients with HLHS.

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Geometry and growth of the reconstructed aorta in patients with hypoplastic left heart syndrome and variants

Abstract: The aortic arch after reconstruction with the interdigitating technique differs from normal. Growth was proportional with no further geometrical distortion. Recoarctation and reintervention rate is low. Further improvement may be achieved by optimizing patch configuration and material.

Cited by 15 publications

References 28 publications

Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair?

Is Decellularized Porcine Small Intestine Sub-mucosa Patch Suitable for Aortic Arch Repair?

The importance of arch geometry after Norwood reconstruction

Abnormal torsion and helical flow patterns of the neo-aorta in hypoplastic left heart syndrome assessed with 4D-flow MRI

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