Ultrasound assessment of mesenteric blood flow in neonates with hypoplastic left heart before and after hybrid palliation

Cozzi, C; Galantowicz, Mark; Cheatham, John P.; Nicholson, Lisa; Fernandez, Richard; Backes, Carl H.; McCaw, Carrie; Clifford, L.

doi:10.1017/s1047951114001607

Cited by 5 publications

(5 citation statements)

References 28 publications

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“…Furthermore, behavioral attitudes, quality of life, and functional status were also reduced ( 44 ). Our review on ND outcome after Hybrid procedure as stage I for HLHS determines an impaired ND outcome in all domains of early childhood development until 3 years of age, comparable to the findings of the Pediatric Heart Network Investigators for the ND outcome after Norwood procedure as stage I ( 19 – 23 , 26 , 30 , 31 ). This includes mild neurological abnormalities with rates between 10% and 35% ( Table 1 ).…”

Section: Discussionsupporting

confidence: 76%

“…The oxygenation balance index between the lower and upper body was lower after Hybrid compared to Norwood procedure as stage I demonstrating impaired cerebral perfusion, which may be due to ongoing retrograde cerebral perfusion after Hybrid procedure as stage I (27). On the other hand, mesenteric perfusion determined by Doppler mesenteric indices improves after Hybrid procedure, which correlates with the potential beneficial effect for the prevention of necrotizing enterocolitis, which is a frequent complication in patients with HLHS by dysbalanced systemic (i.e., cerebral) and pulmonary perfusion (31).…”

Section: Growth Parametersmentioning

confidence: 91%

“…Three studies analyzed the myocardial function comparing Hybrid and Norwood procedure using cardiac MRI or echocardiography (31)(32)(33). At 2-3 years of age, in cardiac MRI, right ventricle (RV) size was larger after Norwood compared to Hybrid procedure, while in both groups, global RV function was preserved but RV myocardial strain was reduced (32).…”

Section: Cardiac Findingsmentioning

confidence: 99%

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Neurodevelopmental and functional outcome in hypoplastic left heart syndrome after Hybrid procedure as stage I

Knirsch

Silvestro²,

Rhein³

2023

Front. Pediatr.

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BackgroundPatients with hypoplastic left heart syndrome (HLHS) undergoing staged palliation until Fontan procedure are at risk for impaired neurodevelopmental (ND) outcome. The Hybrid procedure with bilateral pulmonary artery banding, ductal stenting, and balloon atrioseptostomy may offer a less invasive stage I procedure compared to the Norwood stage I procedure avoiding early neonatal cardiopulmonary bypass (CPB) surgery. Despite altered fetal cerebral hemodynamics, the type of stage I procedure may be a covariate influencing ND outcome and functional outcome may also be altered due to postponing neonatal CPB surgery. Within this review, we analyzed ND outcome as well as functional outcome after Hybrid procedure as stage I procedure.MethodsThe review analyzed original publications (OPs) published before March 15, 2022, identified by Cochrane, EMBASE, OVID, Scopus, and Web of science. An OP was included if short-to-long-term neurodevelopment outcome, brain development, somatic, and cardiac outcome in patients for HLHS and variants treated by Hybrid procedure were analyzed. In addition to database searches, we reviewed all references of the analyzed OP to obtain a comprehensive list of available studies. The author, year of publication, demographic characteristics of study population, study design (prospective or retrospective), study assessment, and main findings were summarized.ResultsTwenty-one OPs were included with data of patients with ND outcome and functional cardiac outcome. Overall, there is an impaired mid-term ND outcome in patients with Hybrid procedure as stage I for HLHS. Only slight differences between stage I procedures (Hybrid vs. Norwood) in two comparing studies have been determined affecting right ventricular remodeling, short- and mid-term ND outcome, reduced brain growth until two years of age, sufficient quality of life, and altered hemodynamics influencing brain volumes and cerebral perfusion pattern.ConclusionsDespite some minor differences regarding the mid-term follow-up in patients with HLHS comparing Hybrid vs. Norwood procedure, its impact on ND outcome seems rather low. This may be explained by the large number of covariates as well as the small study populations and the different selection criteria for patients undergoing Hybrid or Norwood procedure as stage I.

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Section: Discussionsupporting

confidence: 76%

Section: Growth Parametersmentioning

confidence: 91%

Section: Cardiac Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Neurodevelopmental and functional outcome in hypoplastic left heart syndrome after Hybrid procedure as stage I

Knirsch

Silvestro²,

Rhein³

2023

Front. Pediatr.

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“…It is reported that the high prevalence of necrotising enterocolitis in neonates with CHD undergoing either the Norwood or the hybrid procedure may be related to underlying changes in the inflammatory state and gut mucosa that could predispose these neonates to develop necrotising enterocolitis. 21,22 Increased intestinal permeability has been reported in neonates with hypoplastic left heart syndrome both preoperatively and postoperatively, with the changes in permeability persisting for up to 24 hours after surgery. 23,24 Cardiac surgery and cardiopulmonary bypass lead to a systemic inflammatory response caused by the contact of blood with foreign surfaces, ischaemia/reperfusion injury, and endotoxin release from the gastrointestinal tract.…”

Section: Discussionmentioning

confidence: 99%

“…Although improvement of Doppler mesenteric indices of perfusion with preferential flow to the coeliac artery is reported in patients with hypoplastic left heart syndrome after the hybrid procedure, 20 the persistence of altered mesenteric perfusion may contribute to the development of necrotising enterocolitis in patients with hypoplastic left heart syndrome. It is reported that the high prevalence of necrotising enterocolitis in neonates with CHD undergoing either the Norwood or the hybrid procedure may be related to underlying changes in the inflammatory state and gut mucosa that could predispose these neonates to develop necrotising enterocolitis 21 22 Increased intestinal permeability has been reported in neonates with hypoplastic left heart syndrome both preoperatively and postoperatively, with the changes in permeability persisting for up to 24 hours after surgery 23 …”

Section: Discussionmentioning

confidence: 99%

Early hybrid approach and enteral feeding algorithm could reduce the incidence of necrotising enterocolitis in neonates with ductus-dependent systemic circulation

et al. 2016

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Results of a Feeding Protocol in Patients Undergoing the Hybrid Procedure

et al. 2016

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Neonates with single-ventricle physiology are at increased risk of developing gastrointestinal morbidities. Feeding protocols in this patient population have been shown to decrease feeding complications after the Norwood procedure, but no data exist to determine the effectiveness of a feeding protocol in patients undergoing the hybrid procedure. Goal of this study was to examine the impact of a standardized feeding protocol on the incidence of overall postoperative gastrointestinal morbidity after the hybrid procedure. Retrospective chart review was performed on neonates undergoing the hybrid procedure. Neonates were divided into two groups, pre-feeding protocol (pre-FP), which encompassed the years 2002-2008, and post-feeding protocol (post-FP), which encompassed the years 2011-2014. Preoperative, operative, and postoperative data were collected. T test or Fisher's exact test was used for analysis. p < 0.05 was considered significant. Seventy-three neonates were in the pre-FP and 52 neonates were in the post-FP. There were no significant differences between the pre-FP and the post-FP in cardiac diagnosis (62 HLHS, 11 other vs. 39 HLHS, 13 other, respectively). Pre-FP underwent hybrid procedure later than the post-FP (9.1 ± 5.8 vs. 5.7 ± 3.4 days, respectively, p < 0.01) and achieved full enteral feeds earlier than the post-FP (3.2 + 2.9 vs. 7.8 + 3.9 days, respectively, p < 0.01). The incidence of necrotizing enterocolitis was higher in the pre-FP versus post-FP [11.0 % (8/65) vs. 5.8 % (3/49), respectively, p = 0.36]. Though not significant, the incidence of necrotizing enterocolitis decreased by almost 50 % after initiating a feeding protocol in patients undergoing the hybrid procedure. This is consistent with previous studies showing beneficial results of a feeding protocol in this complex patient population.

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Ultrasound assessment of mesenteric blood flow in neonates with hypoplastic left heart before and after hybrid palliation

Abstract: Doppler mesenteric indices of perfusion improve in patients with hypoplastic left heart syndrome after the hybrid procedure; however, there appears to be preferential flow to the coeliac artery versus the superior mesenteric artery in these patients post-procedure.

Cited by 5 publications

References 28 publications

Neurodevelopmental and functional outcome in hypoplastic left heart syndrome after Hybrid procedure as stage I

Neurodevelopmental and functional outcome in hypoplastic left heart syndrome after Hybrid procedure as stage I

Early hybrid approach and enteral feeding algorithm could reduce the incidence of necrotising enterocolitis in neonates with ductus-dependent systemic circulation

Results of a Feeding Protocol in Patients Undergoing the Hybrid Procedure

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