Key result
HLHS infants show higher baseline MPI than controls, with systolic-to-diastolic duration ratio worsening post-palliation.
Why the study?
The effect of Hybrid stage 1 palliation on right ventricular function in infants with hypoplastic left heart syndrome was unknown.
Does Hybrid stage 1 palliation affect right ventricular function in infants with hypoplastic left heart syndrome?
Cohort (n=58)
Does Hybrid stage 1 palliation affect right ventricular function in infants with hypoplastic left heart syndrome?
Absolute Event Rate: 0.47% vs 0.25%
p-value: p=<0.001
Infants with hypoplastic left heart syndrome exhibit baseline right ventricular dysfunction that appears to worsen over the 2 weeks following Hybrid stage 1 palliation.
RV dysfunction present pre-Hybrid in HLHS may worsen post-procedure; leaves open whether this affects survival or warrants modified strategies.
OBJECTIVE: The effect of Hybrid stage 1 palliation for hypoplastic left heart syndrome on right ventricular function is unknown. We sought to compare right ventricular function in normal neonates and those with hypoplastic left heart syndrome before Hybrid palliation and to assess the effect of Hybrid palliation on right ventricular function, using the right ventricular myocardial performance index and the ratio of systolic and diastolic durations. METHODS: We carried out a retrospective review of echocardiographic data on 23 infants with hypoplastic left heart syndrome who underwent Hybrid palliation and 35 normal controls. Data were acquired before Hybrid and after Hybrid palliation - post 1, 0-4 days; post 2, 1 week; post 3, 2-3 weeks; post 4, 1-1.5 months following Hybrid palliation. RESULTS: Myocardial performance index and ratio of systolic and diastolic durations were higher in the pre-Hybrid hypoplastic left heart syndrome group (n=23) - 0.47±0.16 versus 0.25±0.07, p<0.001; 1.59±0.44 versus 1.09±0.14, p<0.0001 - compared with controls (n=35). There was no significant change in the myocardial performance index at any of the post-Hybrid time points. Ratio of systolic and diastolic durations increased significantly 2 weeks after Hybrid - post 3: 2.08±0.62 and post 4: 2.21±0.45 versus pre: 1.59±0.44, p=0.043 and 0.003. There were no significant differences in parameters between sub-groups of infants who died (n=10) and survivors (n=13). CONCLUSIONS: Right ventricular myocardial performance index and ratio of systolic and diastolic durations were significantly higher in infants with hypoplastic left heart syndrome before intervention compared with controls. The ratio of systolic and diastolic durations increased significantly 2 weeks after Hybrid palliation. Our data suggest that infants with hypoplastic left heart syndrome have right ventricular dysfunction before intervention, which worsens over 2 weeks after Hybrid palliation.
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Kobayashi et al. (2015) conducted a cohort in hypoplastic left heart syndrome (n=58). Hybrid stage 1 palliation vs. Normal controls and pre-intervention baseline was evaluated on Right ventricular myocardial performance index (p=<0.001). Infants with hypoplastic left heart syndrome had higher baseline myocardial performance index than controls (0.47 vs 0.25, p<0.001), with systolic/diastolic duration ratio worsening post-palliation.
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