@Article{chd.12834,
AUTHOR = {Andrew S. Kim, Colleen M. Witzenburg, Mark Conaway, Jeffrey E. Vergales, Jeffrey W. Holmes, Thomas J. L’Ecuyer, Peter N. Dean},
TITLE = {Trajectory of right ventricular indices is an early predictor of outcomes in hypoplastic left heart syndrome},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {6},
PAGES = {1185--1192},
URL = {http://www.techscience.com/schd/v14n6/38903},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> Children with hypoplastic left heart syndrome (HLHS) have risk for
mortality and/or transplantation. Previous studies have associated right ventricular
(RV) indices in a single echocardiogram with survival, but none have related serial
measurements to outcomes. This study sought to determine whether the trajectory
of RV indices in the first year of life was associated with transplant‐free survival to
stage 3 palliation (S3P).<br/>
<b>Methods:</b> HLHS patients at a single center who underwent stage 1 palliation (S1P)
between 2000 and 2015 were reviewed. Echocardiographic indices of RV size and
function were obtained before and following S1P and stage 2 palliation (S2P). The
association between these indices and transplant‐free survival to S3P was examined.<br/>
<b>Results:</b> There were 61 patients enrolled in the study with 51 undergoing S2P, 20 S3P,
and 18 awaiting S3P. In the stage 1 perioperative period, indexed RV end‐systolic
area increased in patients who died or needed transplant following S2P, and changed
little in those surviving to S3P (3.37 vs −0.04 cm<sup>2</sup>
/m<sup>2</sup>, P = .017). Increased indexed RV
end‐systolic area was associated with worse transplant‐free survival. (OR = 0.815,
P = .042). In the interstage period, indexed RV end‐diastolic area increased less in
those surviving to S3P (3.6 vs 9.2, P = .03).<br/>
<b>Conclusion:</b> Change in indexed RV end‐systolic area through the stage 1 periopera‐
tive period was associated with transplant‐free survival to S3P. Neither the prestage
nor poststage 1 indexed RV end‐systolic area was associated with transplant‐free
survival to S3P. Patients with death or transplant before S3P had a greater increase in
indexed RV end‐diastolic area during the interstage period. This suggests earlier se‐
rial changes in RV size which may provide prognostic information beyond RV indices
in a single study.},
DOI = {10.1111/chd.12834}
}