Horriat Narges L, Deatsman Sara L, Stelter Jessica, Frommelt Peter C, Hill Garick D
Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Department of Obstetrics and Gynecology, University of Florida, PO Box 100294, Gainesville, FL, 32610, USA.
Pediatr Cardiol. 2016 Dec;37(8):1569-1574. doi: 10.1007/s00246-016-1471-y. Epub 2016 Aug 23.
Initial surgical strategies in neonates with single left ventricular (LV) anatomy vary based on adequacy of pulmonary and systemic blood flow. Differing myocardial responses to these strategies, as reflected in indices of systolic function, ventricular size, and mass have not been well defined. We sought to evaluate single LV myocardial response to varied physiology and initial palliation and determine whether the response is consistent and predictable. Infants with single LV physiology were divided based on neonatal palliation: no palliation/PA band (NO); BT shunt only (BT); or Norwood procedure (NP). Echo measures were obtained at presentation, early post-bidirectional Glenn (BDG), late post-BDG follow-up, and post-Fontan procedure. Measures included ejection fraction, LV mass indexed to height and end diastolic volume indexed to body surface area, and mass/volume ratio. The cohort included 38 children (13 NO, 13 BT, 12 NP). Ejection fraction was similar but depressed in all groups at all stages. LV mass was higher in the NP group than the BT group at early post-BDG (p = 0.03) and higher than both BT and NO groups (p < 0.01) at late post-BDG, but the difference was resolved by post-Fontan follow-up. The NP group had the most remarkable remodeling in LV size from BDG to Fontan, suggesting that volume unloading is most valuable in this subgroup. Ventricular remodeling can be identified by echocardiography in children with single LV physiology, despite variable initial surgical palliative strategies. Importantly, these initial surgical strategies do not result in significant differences after Fontan palliation during early childhood.
具有单一左心室（LV）解剖结构的新生儿的初始手术策略因肺循环和体循环血流量是否充足而有所不同。这些策略所引发的不同心肌反应，如收缩功能指标、心室大小和质量所反映的那样，尚未得到很好的界定。我们试图评估单一左心室心肌对不同生理状态和初始姑息治疗的反应，并确定这种反应是否一致且可预测。具有单一左心室生理状态的婴儿根据新生儿姑息治疗方法进行分组：未进行姑息治疗/肺动脉环扎术（NO）；仅进行体肺分流术（BT）；或诺伍德手术（NP）。在就诊时、双向格林分流术（BDG）早期、BDG晚期随访以及Fontan手术后获取超声心动图测量数据。测量指标包括射血分数、根据身高计算的左心室质量指数、根据体表面积计算的舒张末期容积指数以及质量/容积比。该队列包括38名儿童（13名NO组、13名BT组、12名NP组）。在所有阶段，所有组的射血分数相似但均较低。在BDG早期，NP组的左心室质量高于BT组（p = 0.03），在BDG晚期高于BT组和NO组（p < 0.01），但在Fontan术后随访时差异消失。从BDG到Fontan阶段，NP组左心室大小的重塑最为显著，这表明容量负荷减轻在该亚组中最有价值。尽管初始手术姑息治疗策略不同，但通过超声心动图可在具有单一左心室生理状态的儿童中识别心室重塑。重要的是，这些初始手术策略在幼儿期Fontan姑息治疗后并未导致显著差异。
