Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial

J Thorac Cardiovasc Surg. 2016 Aug;152(2):471-479.e3. doi: 10.1016/j.jtcvs.2016.03.091. Epub 2016 Apr 14.

Abstract

Objectives: Aortic arch reconstruction in children with single ventricle lesions may predispose to circulatory inefficiency and maladaptive physiology leading to increased myocardial workload. We sought to describe neoaortic anatomy and physiology, risk factors for abnormalities, and impact on right ventricular function in patients with single right ventricle lesions after arch reconstruction.

Methods: Prestage II aortic angiograms from the Pediatric Heart Network Single Ventricle Reconstruction trial were analyzed to define arch geometry (Romanesque [normal], crenel [elongated], or gothic [angular]), indexed neoaortic dimensions, and distensibility. Comparisons were made with 50 single-ventricle controls without prior arch reconstruction. Factors associated with ascending neoaortic dilation, reduced distensibility, and decreased ventricular function on the 14-month echocardiogram were evaluated using univariate and multivariable logistic regression.

Results: Interpretable angiograms were available for 326 of 389 subjects (84%). Compared with controls, study subjects more often demonstrated abnormal arch geometry (67% vs 22%, P < .01) and had increased ascending neoaortic dilation (Z score 3.8 ± 2.2 vs 2.6 ± 2.0, P < .01) and reduced distensibility index (2.2 ± 1.9 vs 8.0 ± 3.8, P < .01). Adjusted odds of neoaortic dilation were increased in subjects with gothic arch geometry (odds ratio [OR], 3.2 vs crenel geometry, P < .01) and a right ventricle-pulmonary artery shunt (OR, 3.4 vs Blalock-Taussig shunt, P < .01) but were decreased in subjects with aortic atresia (OR, 0.7 vs stenosis, P < .01) and those with recoarctation (OR, 0.3 vs no recoarctation, P = .04). No demographic, anatomic, or surgical factors predicted reduced distensibility. Neither dilation nor distensibility predicted reduced right ventricular function.

Conclusions: After Norwood surgery, the reconstructed neoaorta demonstrates abnormal anatomy and physiology. Further study is needed to evaluate the longer-term impact of these features.

Trial registration: ClinicalTrials.gov NCT00115934.

Keywords: Norwood; aorta; coarctation.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Video-Audio Media

MeSH terms

  • Aorta, Thoracic / abnormalities
  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / physiopathology
  • Aorta, Thoracic / surgery*
  • Aortic Aneurysm, Thoracic / diagnostic imaging*
  • Aortic Aneurysm, Thoracic / etiology
  • Aortic Aneurysm, Thoracic / physiopathology
  • Aortography*
  • Chi-Square Distribution
  • Dilatation, Pathologic
  • Echocardiography
  • Female
  • Heart Defects, Congenital / diagnostic imaging
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery*
  • Heart Ventricles / abnormalities
  • Heart Ventricles / diagnostic imaging
  • Heart Ventricles / physiopathology
  • Heart Ventricles / surgery*
  • Humans
  • Infant
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Norwood Procedures / adverse effects*
  • Odds Ratio
  • Predictive Value of Tests
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Remodeling*

Associated data

  • ClinicalTrials.gov/NCT00115934