Doppler echocardiographic analysis of flow in the ductus arteriosus of infants with hypoplastic left heart syndrome: Relationship of flow patterns to systemic oxygenation and size of interatrial communication

Rychik, Jack; Gullquist, Scott D; Jacobs, Marshall L.; Norwood, William I.

doi:10.1016/s0894-7317(96)90024-3

Cited by 18 publications

(10 citation statements)

References 12 publications

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“…In the 70 patients with an atrial communication, communication size was scored as follows: small communications ≤2 mm; medium communications = 3–4 mm; and large communications ≥5 mm [16]. Small communications were seen in 22 of 70 (31.4 %) patients (14 of 46 [30.4 %] patients with LDSP versus 8 of 24 [33.3 %] patients with a normally attached atrial septum).…”

Section: Resultsmentioning

confidence: 99%

Leftward Displacement of Septum Primum in Hypoplastic Left Heart Syndrome

Park¹,

Fedderly

Frommelt

et al. 2012

Pediatr Cardiol

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Embryologic development of atrial septum primum antedates formation of the atrioventricular and semilunar valves. Leftward displacement of the superior attachment of septum primum (LDSP) has only been described in hypoplastic left heart syndrome (HLHS). This study reports the frequency of LDSP in HLHS and correlates LDSP with other echocardiographic features of HLHS. Preoperative echocardiograms for 72 consecutive patients with classic HLHS from 1996 to 2002 at Children's Hospital of Wisconsin were reviewed. One patient was excluded for inadequate imaging. Data for the 71 patients included the following: size, location, and Doppler gradient across the atrial septal defect (ASD); location of attachment of septum primum; size and patency of the aortic valve (AoV) annulus; size and patency of the mitral valve (MV) annulus; ascending aorta diameter (AAD); and left-ventricular end diastolic dimension (LVEDD). Patients were categorized into three groups: aortic atresia/mitral atresia (AA/MA), aortic atresia/mitral stenosis (AA/MS), and aortic stenosis/mitral stenosis (AS/MS). LDSP was seen in 46 of 71 patients (64 %). By diagnostic group, 32 of 35 patients with AA/MA had LDSP (91 %) compared with 10 of 19 AA/MS patients (53 %) and 4 of 17 AS/MS patients (24 %), p < 0.05. AoV patency was seen in4 of 46 (9 %) patients with LDSP compared with 13 of 25 (52 %) patients with normal atrial attachment, p < 0.005. Mean left heart dimensions in infants with LDSP compared with normal attachment were as follows: AoV annulus 2.24 versus 3.83 mm, AAD 2.34 versus 4.1 mm, MV annulus 3.21 versus 6.48 mm, and LVEDD 6.38 versus 13.83 mm. By two-way analysis of variance of diagnostic category versus atrial septal attachment with interaction, MV annulus and AAD were independently predicted smaller by LDSP versus normal atrial attachment, p < 0.05. Nonsignificant factors included AoV annulus, LVEDD, ASD size, and Doppler gradient. LDSP correlates with more severe maldevelopment of the left heart in patients with HLHS. Because formation of septum primum precedes development and growth of the intracardiac valves, we speculate that LDSP may be an initiating event in the development of HLHS. In addition, prenatal identification of LDSP may help direct planning of potential in utero therapies.

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Section: Resultsmentioning

confidence: 99%

Leftward Displacement of Septum Primum in Hypoplastic Left Heart Syndrome

Park¹,

Fedderly

Frommelt

et al. 2012

Pediatr Cardiol

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“…the ductus arteriosus in the pre‐CPB or the systemic‐to‐pulmonary shunt (modified Balalock Taussig) in the post‐CPB period]. The pulmonary flow during the prebypass period depends almost exclusively on the pulmonary vascular resistance becuase there is free flow through the pulmonary artery (5). Once the first stage is completed, the blood flow is now determined by the systemic‐to‐pulmonary shunt diameter.…”

Section: Discussionmentioning

confidence: 99%

Combining low inspired oxygen and carbon dioxide during mechanical ventilation for the Norwood procedure

Keidan¹,

Mishaly

Berkenstadt³

et al. 2003

Pediatric Anesthesia

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“…The pattern of flow in the ductus arteriosus after birth will be determined by the resistances in the systemic and pulmonary circulations and is phasic in some infants with hypoplastic left heart syndrome [41]. During systole blood will flow from the pulmonary artery to the aorta but if pulmonary vascular resistance is low, there may be a small amount of backflow from the aorta to the pulmonary artery during diastole.…”

Section: Ductus Arteriosusmentioning

confidence: 99%

Aortic Atresia, Mitral Atresia, and Hypoplastic Left Ventricle

Rudolph

2009

Congenital Diseases of the Heart

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Doppler echocardiographic analysis of flow in the ductus arteriosus of infants with hypoplastic left heart syndrome: Relationship of flow patterns to systemic oxygenation and size of interatrial communication

Cited by 18 publications

References 12 publications

Leftward Displacement of Septum Primum in Hypoplastic Left Heart Syndrome

Leftward Displacement of Septum Primum in Hypoplastic Left Heart Syndrome

Combining low inspired oxygen and carbon dioxide during mechanical ventilation for the Norwood procedure

Aortic Atresia, Mitral Atresia, and Hypoplastic Left Ventricle

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