TY - JOUR
T1 - Right ventricular morphology and function following stage I palliation with a modified Blalock-Taussig shunt versus a right ventricle-to-pulmonary artery conduit
AU - Wong, James
AU - Lamata, Pablo
AU - Rathod, Rahul H.
AU - Bertaud, Sophie
AU - Dedieu, Nathalie
AU - Bellsham-Revell, Hannah
AU - Pushparajah, Kuberan
AU - Razavi, Reza
AU - Hussain, Tarique
AU - Schaeffter, Tobias
AU - Powell, Andrew J.
AU - Geva, Tal
AU - Greil, Gerald F.
N1 - Funding Information:
This study has received funding by the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust and by Action Medical Research (grant code GN2401). Pablo Lamata holds a Sir Henry Dale Fellowship funded jointly by the Wellcome Trust and the Royal Society (grant no. 099973/Z/12/Z). The Division of Imaging Sciences receives support as the Centre of Excellence in Medical Engineering (funded by the Wellcome Trust and EPSRC; grant no. WT 088641/Z/09/Z) as well as the BHF Centre of Excellence (British Heart Foundation award RE/08/03). Nathalie Dedieu was funded through a BHF grant (PG/12/5/ 29350). The MRI scanner at King’s College London is partly supported by Philips Healthcare. Rahul H. Rathod, Andrew J. Powell and Tal Geva were supported in part by the Higgins Family Non-invasive Cardiac Imaging Research Fund. Funding to pay the Open Access publication charges for this article was provided by the Wellcome Trust (grant no. 099973/Z/12/Z).
Publisher Copyright:
© The Author 2016.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - OBJECTIVES: The Norwood procedure for hypoplastic left heart syndrome (HLHS) is performed either via a right ventricle-to-pulmonary artery (RVPA) conduit or a modified Blalock-Taussig (MBT) shunt. Cardiac magnetic resonance (CMR) data was used to assess the effects of the RVPA conduit on ventricular shape and function through a computational analysis of anatomy and assessment of indices of strain. METHODS: A retrospective analysis of 93 CMR scans of subjects with HLHS was performed (59 with MBT shunt, 34 with RVPA conduit), incorporating data at varying stages of surgery from two congenital centres. Longitudinal and short-axis cine images were used to create a computational cardiac atlas and assess global strain. RESULTS: Those receiving an RVPA conduit had significant differences (P < 0.0001) in the shape of the RV corresponding to increased ventricular dilatation (P = 0.001) and increased sphericity (P = 0.006). Differences were evident only following completion of stage II surgery. Despite preserved ejection fraction in both groups, functional strain in the RVPA conduit group compared with that in the MBT shunt group was reduced across multiple ventricular axes, including a reduced systolic longitudinal strain rate (P < 0.0001), reduced diastolic longitudinal strain rate (P = 0.0001) and reduced midventricular systolic circumferential strain (P < 0.0001). CONCLUSIONS: Computational modelling analysis reveals differences in ventricular remodelling in patients with HLHS undergoing an RVPA conduit insertion with focal scarring and volume loading leading to decreased functional markers of strain. The need for continued surveillance is warranted, as deleterious effects may not become apparent until later years.
AB - OBJECTIVES: The Norwood procedure for hypoplastic left heart syndrome (HLHS) is performed either via a right ventricle-to-pulmonary artery (RVPA) conduit or a modified Blalock-Taussig (MBT) shunt. Cardiac magnetic resonance (CMR) data was used to assess the effects of the RVPA conduit on ventricular shape and function through a computational analysis of anatomy and assessment of indices of strain. METHODS: A retrospective analysis of 93 CMR scans of subjects with HLHS was performed (59 with MBT shunt, 34 with RVPA conduit), incorporating data at varying stages of surgery from two congenital centres. Longitudinal and short-axis cine images were used to create a computational cardiac atlas and assess global strain. RESULTS: Those receiving an RVPA conduit had significant differences (P < 0.0001) in the shape of the RV corresponding to increased ventricular dilatation (P = 0.001) and increased sphericity (P = 0.006). Differences were evident only following completion of stage II surgery. Despite preserved ejection fraction in both groups, functional strain in the RVPA conduit group compared with that in the MBT shunt group was reduced across multiple ventricular axes, including a reduced systolic longitudinal strain rate (P < 0.0001), reduced diastolic longitudinal strain rate (P = 0.0001) and reduced midventricular systolic circumferential strain (P < 0.0001). CONCLUSIONS: Computational modelling analysis reveals differences in ventricular remodelling in patients with HLHS undergoing an RVPA conduit insertion with focal scarring and volume loading leading to decreased functional markers of strain. The need for continued surveillance is warranted, as deleterious effects may not become apparent until later years.
KW - Cardiac MRI
KW - Hypoplastic left heart syndrome
KW - Norwood procedure
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U2 - 10.1093/ejcts/ezw227
DO - 10.1093/ejcts/ezw227
M3 - Article
C2 - 27422888
AN - SCOPUS:85015403888
SN - 1010-7940
VL - 51
SP - 50
EP - 57
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 1
ER -