TY - EJOU
AU - Zielonka, Benjamin
AU - Harrild, David M.
AU - Ghelani, Sunil J.
AU - Elia, Eleni G.
AU - Baird, Christopher W.
AU - Powell, Andrew J.
AU - Rathod, Rahul H.
TI - A Ring-Reinforced Right Ventricle to Pulmonary Artery Conduit is Associated with Better Regional Mechanics after Stage I Norwood Operation
T2 - Congenital Heart Disease
PY - 2022
VL - 17
IS - 5
SN - 1747-0803
AB - Background: The right ventricle to pulmonary artery conduit (RVPAC) may impair right ventricular (RV) function in patients with functional single right ventricles. Modification of the RVPAC using a ring-reinforced end
with dunked insertion into the RV through a limited ventriculotomy may reduce the impact on RV function.
We compared RV segmental strain between patients with a traditional RVPAC and ring-reinforced RVPAC using
feature tracking cardiovascular magnetic resonance (CMR) imaging. Methods: Patients with CMR examinations
after Stage I operation with RVPAC between 2000 and 2018 were reviewed. Ventricular mass, volumes, late gadolinium enhancement (LGE), and peak radial and circumferential strain of the 4 segments near the RVPAC insertion site were analyzed. Results: The study included 71 CMR examinations in 61 patients (30 traditional RVPAC,
31 ring-reinforced RVPAC). Prior to Stage II, the ring-reinforced RVPAC group had better peak radial strain and
circumferential strain in 1 of 4 segments proximal to the RVPAC insertion site compared to the traditional
RVPAC group. Prior to Stage III operation, the ring-reinforced group had better peak radial and circumferential
strain in 2 of 4 segments. LGE at the RVPAC insertion site was observed in 97% of patients before Stage II and
95% of patients before Stage III. RVPAC type and regional strain were not associated with transplant-free survival
during a median follow-up of 6.3 years. Conclusions: Compared to a traditional RVPAC, the ring-reinforced
RVPAC is associated with improved regional mechanics at the conduit insertion site. Further investigation of
long-term outcomes after ring-reinforced RVPAC is warranted.
KW - Single ventricle; hypoplastic left heart syndrome; cardiovascular magnetic resonance; feature tracking
DO - 10.32604/chd.2022.021509