Right Ventricular Remodeling in Hypoplastic Left Heart Syndrome is Minimally Impacted by Cardiopulmonary Bypass: A Compa
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ORIGINAL ARTICLE
Right Ventricular Remodeling in Hypoplastic Left Heart Syndrome is Minimally Impacted by Cardiopulmonary Bypass: A Comparison of Norwood vs. Hybrid Kandice Mah1 · Jesus Serrano Lomelin1 · Timothy Colen1 · Edythe B. Tham1 · Lily Lin1 · Luke Eckersley1 · Jeffrey F. Smallhorn1 · Harald Becher2 · Luc Mertens3 · Nee Scze Khoo1 Received: 6 June 2020 / Accepted: 29 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Right ventricular (RV) remodeling in hypoplastic left heart syndrome (HLHS) begins prenatally and continues through staged palliations. However, it is unclear if the most marked observed remodeling post-Norwood is secondary to cardiopulmonary bypass (CPB) exposure or if it is an adaptation intrinsic to the systemic RV. This study aims to determine the impact of CPB on RV remodeling in HLHS. Echocardiograms of HLHS survivors undergoing stage 1 Norwood (n = 26) or Hybrid (n = 20) were analyzed at pre- and post-stage 1, pre- and post-bidirectional cavo-pulmonary anastomosis (BCPA), and pre-Fontan. RV fractional area change (FAC), vector velocity imaging for longitudinal & derived circumferential deformation (global radial shortening (GRS) = peak radial displacement/end-diastolic diameter), and deformation ratio (longitudinal/ circumferential) were assessed. Both groups had similar age, clinical status and functional parameters pre-stage 1. No difference in RV size and sphericity at any stage between groups. RVFAC was normal (> 35%) throughout for both groups. Both Norwood and Hybrid patients had increased GRS (p = 0.0001) post-stage 1 and corresponding unchanged longitudinal strain, resulting in decreased deformation ratio (greater relative RV circumferential contraction), p = 0.0001. Deformation ratio remained decreased in both groups in subsequent stages. Irrespective of timing of the first CPB exposure, both Norwood and Hybrid patients underwent similar RV remodeling, with relative increase in circumferential to longitudinal contraction soon after stage 1 palliation. The observed RV remodeling in HLHS survivors were minimally impacted by CPB. Keywords Single ventricle · Hypoplastic left heart syndrome · Adaptation · Cardiac function Abbreviations RV Right ventricle HLHS Hypoplastic left heart syndrome CPB Cardiopulmonary bypass
BCPA Bidirectional cavo-pulmonary anastomosis FAC Fractional area change DHCA Deep hypothermic circulatory arrest
* Nee Scze Khoo [email protected]
Jeffrey F. Smallhorn [email protected]
Kandice Mah [email protected]
Harald Becher [email protected]
Jesus Serrano Lomelin [email protected]
Luc Mertens [email protected]
Timothy Colen [email protected]
1
Division of Pediatric Cardiology, Stollery Children’s Hospital, 8440 112 St NW, unit 4C2.36, Edmonton, AB T6G2B7, Canada
2
Mazankowski Alberta Heart Institute, Alberta Health Services, 11220 83 Ave NW, Edmonton, AB T6G 2B7, Canada
3
Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G1
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