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

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Presentation transcript:

Maladaptive aortic properties after the Norwood procedure: An angiographic analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Sarah T. Plummer, MD, Christoph P. Hornik, MD, MPH, Hamilton Baker, MD, Gregory A. Fleming, MD, MS, Susan Foerster, MD, M. Eric Ferguson, MD, Andrew C. Glatz, MD, MSCE, Russel Hirsch, MD, Jeffrey P. Jacobs, MD, Kyong-Jin Lee, MD, Alan B. Lewis, MD, Jennifer S. Li, MD, MS, Mary Martin, MD, Diego Porras, MD, Wolfgang A.K. Radtke, MD, John F. Rhodes, MD, Julie A. Vincent, MD, Jeffrey D. Zampi, MD, Kevin D. Hill, MD, MS The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 2, Pages 471-479.e3 (August 2016) DOI: 10.1016/j.jtcvs.2016.03.091 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Arch geometry in the SVR trial cohort (neoaorta) and single ventricle controls. The P value shown (<.001) is for individual comparisons. The Romanesque arch has a smooth semicircular form with an approximate 1:1 height to width ratio, the crenel arch has a rectangular form with width greater than height, and the gothic arch has an angular appearance with height greater than length. B, Representative examples of neoaortic morphology and geometry. i, Romanesque (normal) arch geometry; ii, crenel arch geometry; iii, ascending neoaortic dilation; iv, recoarctation. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 471-479.e3DOI: (10.1016/j.jtcvs.2016.03.091) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Variability was seen in neoaortic arch geometric classification between PHN centers. B, Reconstructed neoaortas had a greater aortic index when compared with the single-ventricle control population. Significant center variability was seen again. PHN, Pediatric Heart Network; LV, left ventricle; Asc, ascending; Ao, aorta; Desc, descending. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 471-479.e3DOI: (10.1016/j.jtcvs.2016.03.091) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 This video provides snapshot views of angiograms from all of the SVR trial aortae demonstrating the wide variability in aortic morphology. Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)30114-3/addons. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 471-479.e3DOI: (10.1016/j.jtcvs.2016.03.091) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Arch diameter measurements were made in the lateral angiographic projection in the following locations: ascending aorta at the largest point (systole and diastole), proximal transverse arch, distal transverse arch, isthmus at the narrowest point, descending aorta at the largest point of poststenotic dilation, and descending aorta at the diaphragm (systole and diastole). The Journal of Thoracic and Cardiovascular Surgery 2016 152, 471-479.e3DOI: (10.1016/j.jtcvs.2016.03.091) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

After the Norwood, the neoaorta shows abnormal geometry and ascending aortic dilation. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 471-479.e3DOI: (10.1016/j.jtcvs.2016.03.091) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions