Right Ventricular Mechanical Dyssynchrony and Asymmetric Contraction in Hypoplastic Heart Syndrome are Associated with Tricuspid Regurgitation

Bharucha, Tara; Khan, Rubeena; Mertens, Luc; Friedberg, Mark K.

doi:10.1016/j.echo.2013.06.015

Cited by 28 publications

(15 citation statements)

References 31 publications

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“…Other contributive factors are underlying structural TV abnormalities, mechanical RV dyssynchrony, and regional functional abnormalities 13. Especially between stage I and II, volume loading related to the parallel circulations has been posed as a contributive factor to interstage TR progression 13. This may be supported by findings of our study, as significantly increased TV dimensions were present in both groups, especially at pre-stage II, in combination with often significant TR.…”

Section: Discussionsupporting

confidence: 77%

“…TR can be secondary to ventricular dysfunction, and increased volume loading related to significant TR can lead to further RV dysfunction 1 3 4. Other contributive factors are underlying structural TV abnormalities, mechanical RV dyssynchrony, and regional functional abnormalities 13. Especially between stage I and II, volume loading related to the parallel circulations has been posed as a contributive factor to interstage TR progression 13.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Norwood versus hybrid palliation on cardiac size and function in hypoplastic left heart syndrome

Grotenhuis

Ruijsink

Chetan

et al. 2016

Heart

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Impact of Norwood versus hybrid palliation on cardiac size and function in hypoplastic left heart syndrome

Grotenhuis

Ruijsink

Chetan

et al. 2016

Heart

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“…Dysfunction of the single ventricle determines the occurrence of other complications that increase the risk of death in the early postoperative period. Bharucha et al [ 14 ] demonstrated that right ventricular mechanical dyssynchrony and inhomogeneous contraction were worse in patients with clinically important tricuspid regurgitation and HLHS. Ventricular dysfunction leads to atrioventricular regurgitation, which in time results in progressive circulatory insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Preoperative single ventricle function determines early outcome after second-stage palliation of single ventricle heart

Pająk

Buczyński

Stanek

et al. 2017

Cardiovasc Ultrasound

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BackgroundSecond-stage palliation with hemi-Fontan or bidirectional Glenn procedures has improved the outcomes of patients treated for single-ventricle heart disease. The aim of this study was to retrospectively analyze risk factors for death after second-stage palliation of single-ventricle heart and to compare therapeutic results achieved with the hemi-Fontan and bidirectional Glenn procedures.Material and methodsWe analyzed 60 patients who had undergone second-stage palliation for single-ventricle heart. Group HF consisted of 23 (38.3%) children who had been operated with the hemi-Fontan method; Group BDG consisted of 37 (61.7%) who had been operated with the bidirectional Glenn method. The analysis focused on 30-day postoperative mortality rates, clinical and echocardiographic data, and early complications.ResultsThe patients’ ages at the time of repair was 33 ± 11.2 weeks; weight was 6.7 ± 1.2 kg. The most common anatomic subtype was hypoplastic left heart syndrome, in 36 (60%) patients. The early mortality rate was 13.3%. Significant preoperative atrioventricular valve regurgitation, single-ventricle heart dysfunction, pneumonia/sepsis, and arrhythmias were associated with higher mortality rates after second-stage palliation. Multivariate analysis identified significant preoperative single-ventricle heart dysfunction as an independent predictor of early death after second-stage palliation. No differences were found in the analyzed variables after bidirectional Glenn compared with hemi-Fontan procedures.ConclusionSignificant preoperative atrioventricular valve regurgitation, arrhythmias and pneumonia/sepsis are closely correlated with mortality in patients with single-ventricle heart after second-stage palliation. Preoperative significant single-ventricle heart dysfunction is an independent mortality predictor in this group of patients. There are no differences in clinical, echocardiographic data, or outcomes in patients treated with the hemi-Fontan compared with bidirectional Glenn procedures.

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“…We have previously reported feasibility figures for normal children in the range of 91–96% for segmental longitudinal deformation and 97–100% for global longitudinal deformation [ 6 , 24 ]. Previous studies using STE in children and adults with single ventricle morphology report feasibility between 63 and 100% for longitudinal strain [ 9 , 19 , 25 ], although some studies do not provide information on feasibility [ 17 , 22 , 26 ]. Based on our own experience and publications by other groups, we conclude that feasibility of STE in patients with single ventricle morphology is modest, probably due to poor acoustic window as a result of abnormal anatomy (e.g., missing segments in the setting of large ventricular septum defects) and/or various thoracotomies.…”

Section: Discussionmentioning

confidence: 99%

“…Reproducibility data are not reported in many studies using STE in children and adults with a TCPC [ 8 , 17 , 27 ]. Some studies use inter-class correlation coefficients to report on intra- and inter-observer reproducibility and found figures in the range of 0.8 for both longitudinal strain and SR [ 19 , 26 ]. Others use COV which were found to be between 3 and 25% for both strain and SR. [ 9 , 18 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Myocardial Deformation Does Not Predict Single Ventricle Ejection Fraction Assessed by Cardiac Magnetic Resonance Imaging in Children with a Total Cavopulmonary Connection

et al. 2017

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Survival of children with single ventricle heart defects after the total cavopulmonary connection (TCPC) has improved, but impaired cardiac function remains a major cause of morbidity and mortality. Cardiac magnetic resonance imaging (cMRI) is the gold standard in assessing single ventricle volume and function, but high costs and limited availability hamper its routine use. A cheaper and more available alternative is echocardiography. Myocardial function can be studied in more detail using speckle tracking echocardiography (STE). The purpose of the study was to describe the association between myocardial deformation assessed by speckle tracking echocardiography (STE) and single ventricle function assessed by cMRI and to evaluate differences in myocardial deformation in children with single left and single right ventricular morphology. Cross-sectional, multicenter study in 77 children after TCPC was conducted. STE segmental and global longitudinal peak strain and systolic strain rate (SR) of the dominant ventricle were measured. Impaired SV function by cMRI was defined as ejection fraction (EF) < 45%. Mean age was 11.8 (range 9.7–14.3) years. Pearson R for cMRI EF versus global longitudinal strain and SR was − 0.25 (p = 0.06) and − 0.03 (p = 0.82), respectively. Global single ventricle longitudinal strain and SR was similar in patients after TCPC with single left and single right ventricular morphology (− 19.0 ± 3.1% vs 19.2 ± 3.2%, p = 0.94). STE myocardial deformation parameters do not correlate with single ventricle ejection fraction assessed by cMRI.

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Right Ventricular Mechanical Dyssynchrony and Asymmetric Contraction in Hypoplastic Heart Syndrome are Associated with Tricuspid Regurgitation

Cited by 28 publications

References 31 publications

Impact of Norwood versus hybrid palliation on cardiac size and function in hypoplastic left heart syndrome

Impact of Norwood versus hybrid palliation on cardiac size and function in hypoplastic left heart syndrome

Preoperative single ventricle function determines early outcome after second-stage palliation of single ventricle heart

Longitudinal Myocardial Deformation Does Not Predict Single Ventricle Ejection Fraction Assessed by Cardiac Magnetic Resonance Imaging in Children with a Total Cavopulmonary Connection

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