Ventriculoarterial coupling in palliated hypoplastic left heart syndrome: Noninvasive assessment of the effects of surgical arch reconstruction and shunt.

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Ventriculoarterial coupling in palliated hypoplastic left heart syndrome: Noninvasive assessment of the effects of surgical arch reconstruction and shunt type Giovanni Biglino, PhD, Alessandro Giardini, MD, Hopewell N. Ntsinjana, MD, Silvia Schievano, PhD, Tain-Yen Hsia, MD, Andrew M. Taylor, MD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 4, Pages 1526-1533 (October 2014) DOI: 10.1016/j.jtcvs.2014.02.012 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Examples of 3-dimensional (3D) volumes obtained from the 3D whole heart sequences, highlighting the planes selected for calculation of the cross-sectional areas of the transverse arch (At), isthmus/narrowing (An), and descending aorta (Ad). Two coractation indexes were computed for each patient (area ratio of the isthmus to the descending aorta [Risthmus] and of the isthmus to the surgically enlarged transverse arch [Rarch] = An/At). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1526-1533DOI: (10.1016/j.jtcvs.2014.02.012) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Calculation of wave speed c from the relationship between the velocity and area in the ascending aorta, with c yielded directly from the slope of the initial portion of the loop, when no reflected waves were expected in early systole. B, Sample of wave intensity (dI) profile, including forward and backward wave intensity (dI+ and dI−, respectively) separated by knowledge of the wave speed,19 highlighting the peaks of the forward compression wave (FCW) in early systole and forward expansion wave (FEW) at end systole. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1526-1533DOI: (10.1016/j.jtcvs.2014.02.012) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, No relationship was found between the aortic distensibility and the interval from the Norwood procedure (approximately indicated by patient age at scanning). B, No relationship was found between the area ratio of the isthmus to the descending aorta (Rishtmus) and the peak of the forward compression wave (FCW) as an indicator of the ventricular maximum rate of pressure rise. C, A significant correlation was found between the peak FCW and the area ratio of the isthmus to the surgically enlarged transverse arch (Rarch), as an indicator of the size mismatch between the reconstructed aortic arch and the native descending aorta. D, A significant correlation indicated that patients with a lower ejection fraction (EF) also exhibited greater values of the indexed single ventricle mass (iSVM). The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1526-1533DOI: (10.1016/j.jtcvs.2014.02.012) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Differences between patients with modified Blalock-Taussig (mBT) shunt and Sano shunt at the Norwood procedure were evaluated in terms of the following parameters: aortic distensibility, ejection fraction (EF), indexed end-diastolic volume (iEDV), indexed end-systolic volume (iESV), and—from the wave intensity analysis results—peak forward compression wave (FCW) and peak forward expansion wave (FEW). iSVM, Indexed single ventricle mass. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 1526-1533DOI: (10.1016/j.jtcvs.2014.02.012) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions