Objective
To evaluate fibrosis and fibrosis-related gene expression in the myocardium of pediatric single ventricle (SV) subjects with right ventricular (RV) failure.
Study design
Real-time quantitative polymerase chain reaction was performed on explanted RV myocardium of pediatric SV subjects and non-failing controls. Subjects were divided into 3 groups: SV failing (SV-F, RV failure prior to or following Stage I palliation), SV non-failing (SV-NF, infants listed for primary transplant with normal RV function), and Stage III (Fontan or RV failure following Stage III). In order to evaluate subjects of similar age and RV volume loading, SV-F was compared with SV-NF and Stage III was compared with NF RV. Histologic fibrosis was assessed in all hearts. Mann-Whitney tests were performed to identify differences in gene expression.
Results
Collagen (Col1α, Col3) expression is decreased in SV-F compared with SV-NF (P = .019 and p=0.035, respectively), and is equivalent in Stage III compared with NF RV. Tissue inhibitors of metalloproteinase (TIMPs1, 3 and 4) are down-regulated in Stage III compared with NF RV (p=0.0047, p=0.013 and p=0.013, respectively). Matrix metalloproteinases (MMP2, MMP9) are similar between SV-NF and SV-F, and between Stage III and NF RV. There is no difference in the prevalence of RV fibrosis by histology in SV subjects with RV failure (18%) compared with those with normal RV function (38%).
Conclusions
Fibrosis is not a primary contributor to RV failure in infants and young children with SV. Additional studies are required to understand whether anti-fibrotic therapies are beneficial in this population.