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Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial.

Publication ,  Journal Article
Plummer, ST; Hornik, CP; Baker, H; Fleming, GA; Foerster, S; Ferguson, ME; Glatz, AC; Hirsch, R; Jacobs, JP; Lee, K-J; Lewis, AB; Li, JS ...
Published in: J Thorac Cardiovasc Surg
August 2016

OBJECTIVES: Aortic arch reconstruction in children with single ventricle lesions may predispose to circulatory inefficiency and maladaptive physiology leading to increased myocardial workload. We sought to describe neoaortic anatomy and physiology, risk factors for abnormalities, and impact on right ventricular function in patients with single right ventricle lesions after arch reconstruction. METHODS: Prestage II aortic angiograms from the Pediatric Heart Network Single Ventricle Reconstruction trial were analyzed to define arch geometry (Romanesque [normal], crenel [elongated], or gothic [angular]), indexed neoaortic dimensions, and distensibility. Comparisons were made with 50 single-ventricle controls without prior arch reconstruction. Factors associated with ascending neoaortic dilation, reduced distensibility, and decreased ventricular function on the 14-month echocardiogram were evaluated using univariate and multivariable logistic regression. RESULTS: Interpretable angiograms were available for 326 of 389 subjects (84%). Compared with controls, study subjects more often demonstrated abnormal arch geometry (67% vs 22%, P < .01) and had increased ascending neoaortic dilation (Z score 3.8 ± 2.2 vs 2.6 ± 2.0, P < .01) and reduced distensibility index (2.2 ± 1.9 vs 8.0 ± 3.8, P < .01). Adjusted odds of neoaortic dilation were increased in subjects with gothic arch geometry (odds ratio [OR], 3.2 vs crenel geometry, P < .01) and a right ventricle-pulmonary artery shunt (OR, 3.4 vs Blalock-Taussig shunt, P < .01) but were decreased in subjects with aortic atresia (OR, 0.7 vs stenosis, P < .01) and those with recoarctation (OR, 0.3 vs no recoarctation, P = .04). No demographic, anatomic, or surgical factors predicted reduced distensibility. Neither dilation nor distensibility predicted reduced right ventricular function. CONCLUSIONS: After Norwood surgery, the reconstructed neoaorta demonstrates abnormal anatomy and physiology. Further study is needed to evaluate the longer-term impact of these features.

Duke Scholars

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

August 2016

Volume

152

Issue

2

Start / End Page

471 / 479.e3

Location

United States

Related Subject Headings

  • Vascular Remodeling
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Randomized Controlled Trials as Topic
  • Predictive Value of Tests
  • Odds Ratio
  • Norwood Procedures
 

Citation

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Plummer, S. T., Hornik, C. P., Baker, H., Fleming, G. A., Foerster, S., Ferguson, M. E., … Hill, K. D. (2016). Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial. J Thorac Cardiovasc Surg, 152(2), 471-479.e3. https://doi.org/10.1016/j.jtcvs.2016.03.091
Plummer, Sarah T., Christoph P. Hornik, Hamilton Baker, Gregory A. Fleming, Susan Foerster, M Eric Ferguson, Andrew C. Glatz, et al. “Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial.J Thorac Cardiovasc Surg 152, no. 2 (August 2016): 471-479.e3. https://doi.org/10.1016/j.jtcvs.2016.03.091.
Plummer ST, Hornik CP, Baker H, Fleming GA, Foerster S, Ferguson ME, et al. Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial. J Thorac Cardiovasc Surg. 2016 Aug;152(2):471-479.e3.
Plummer, Sarah T., et al. “Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial.J Thorac Cardiovasc Surg, vol. 152, no. 2, Aug. 2016, pp. 471-479.e3. Pubmed, doi:10.1016/j.jtcvs.2016.03.091.
Plummer ST, Hornik CP, Baker H, Fleming GA, Foerster S, Ferguson ME, Glatz AC, Hirsch R, Jacobs JP, Lee K-J, Lewis AB, Li JS, Martin M, Porras D, Radtke WAK, Rhodes JF, Vincent JA, Zampi JD, Hill KD. Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial. J Thorac Cardiovasc Surg. 2016 Aug;152(2):471-479.e3.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

August 2016

Volume

152

Issue

2

Start / End Page

471 / 479.e3

Location

United States

Related Subject Headings

  • Vascular Remodeling
  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Randomized Controlled Trials as Topic
  • Predictive Value of Tests
  • Odds Ratio
  • Norwood Procedures