Key result
Systemic-to-pulmonary shunts in pulmonary atresia are linked to ~10% lower LVEF versus controls.
Why the study?
Does a modified Blalock-Taussig shunt alter left ventricular systolic and diastolic function in patients with pulmonary atresia with intact ventricular septum compared to matched controls?
Case-Control (n=22)
Does a modified Blalock-Taussig shunt alter left ventricular systolic and diastolic function in patients with pulmonary atresia with intact ventricular septum compared to matched controls?
Patients with pulmonary atresia with intact ventricular septum show progressive compromise of left ventricular systolic and diastolic function after systemic-to-pulmonary arterial shunting, suggesting earlier biventricular or Fontan procedures may be warranted.
Reduced ejection fraction after shunt; leaves open whether modified timing of repair improves ventricular outcomes in pulmonary atresia.
To investigate the left ventricular systolic and diastolic function in patients with pulmonary atresia with intact ventricular septum without coronary-cardiac fistulas after a modified Blalock-Taussig shunt, 14 patients (age range 15 days-16.5 months, mean 4.03±5.6 months) and eight control subjects, matched for age, body surface area and heart rate were evaluated by cross-sectional and Doppler echocardiography. The follow-up interval after palliative procedures ranged from 12 days to 16.3 months (mean 3.67±5.6 months). Compared to controls, in the group of patients the ejection fraction was decreased (61±7% vs 68±5%, p=0.022) while the left ventricular end-diastolic volume indexed for body surface area was increased (72.7±10.8 cc/m246.1±12 cc/m2p=0.0001) with normal values of left ventricular mass indexed for body surface area (67.88±20.9 g/m2vs 76±10 g/m2p=NS). Mass-to-volume ratio was lower in patients with pulmonary atresia (0.95±0.38 vs 1.24±0.3, p=0.031). The left ventricular shape index was increased in all patients with pulmonary atresia (1.27±0.26 vs 1±0.01, p=0.009). A significant inverse correlation was noted between the ejection fraction and follow-up (r=−0.71, p=0.04). as well as between the ejection fraction and shape index (r=−0.76, p=0.048). Moreover, the patients with pulmonary atresia had decreased E/A velocity ratio (0.65±0.16 vs 1.35±0.90, p=0.009), decreased normalized peak filling rate (4.16±0.13 sv/s vs 6.88±0.68 sv/s, p=0.0001), increased peak A velocity (0.95±0.17 m/s vs 0.51±0.16 m/s, p=0.0001) and prolonged isovolumic relaxation time (46±5.4 ms vs 34±6.2 ms, p=0.0001) and deceleration time (196.4±32.2 ms vs 116±21.4 ms, p=0.0001). There was a good correlation between the normalized peak filling rate and follow-up (r=−0.80, p=0.04). These data show a progressive compromise of the left ventricular systolic and diastolic function in patients with pulmonary atresia with intact ventricular septum without ventriculocoronary fistulas who had undergone systemic-to-pulmonary arterial shunting. Thus, an earlier biventricular or Fontan type procedure should be recommended.
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Pacileo et al. (1994) conducted a case-control in Pulmonary atresia with intact ventricular septum (n=22). Pulmonary atresia with intact ventricular septum after systemic-to-pulmonary arterial shunt vs. Matched control subjects was evaluated on Ejection fraction (p=0.022). Patients with pulmonary atresia with intact ventricular septum after a systemic-to-pulmonary shunt had decreased ejection fraction compared to controls (61% vs 68%, p=0.022).
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