Abstract
The objective of this study was to compare histopathological changes in hypoplastic left heart syndrome right ventricles (RV) of patients undergoing Sano and modified Blalock–Taussig (MBT) shunt and correlate them with echocardiographic findings. Myocardial tissue samples were obtained from hearts with Sano or MBT shunts after transplantation or at autopsy. Histologic sections were reviewed manually and by automated digital image analysis. Velocity vector imaging was performed on echocardiogram images obtained before transplant or death. All of these parameters were compared between the Sano and MBT shunt cohorts. A total of 14 specimens (7 Sano and 7 MBT shunt) were studied. Median age at transplant/death of Sano and MBT shunt cohorts was 11 (range 2–41) and 8 months (range 2–200), respectively. All Sano specimens had a scar at ventriculotomy site, and the mean scar area was 6.2 ± 3.3 cm2. Compared with remote RV free wall, myocardium bordering the scar showed increased fibrosis (34 ± 16 % vs. 28 ± 14 %, p = 0.04) and thinning (0.8 ± 0.9 vs. 5.3 ± 0.8 mm; p < 0.001), which did not regress with time. The Sano ventriculotomy site showed significantly decreased velocity, strain, and strain rate compared with the corresponding contralateral segment. No focal scarring or regional hypokinesia was seen in the MBT shunt cohort. This is the first study to demonstrate histopathological features of ventriculotomy-associated RV myocardial scarring and myocardial thinning. The scarred ventriculotomy site showed decreased segmental myocardial deformation after Norwood with Sano shunt.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bacha EA, Zimmerman FJ, Mor-Avi V, Weinert L, Starr JP, Sugeng L, Lang RM (2004) Ventricular resynchronization by multisite pacing improves myocardial performance in the postoperative single-ventricle patient. Ann Thorac Surg 78:1678–1683
Feinstein JA, Benson DW, Dubin AM, Cohen MS, Maxey DM, Mahle WT et al (2012) Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 59(1 Suppl):S1–S42
Horer J, Malcic I, Schreiber C, Lange R (2011) False aneurysm origination from the proximal anastomosis of a right ventricular to pulmonary artery shunt following staged repair of hypoplastic left heart syndrome. Interact Cardiovasc Thorac Surg 12(3):487–489
Hsu DT, Zak V, Mahony L, Sleeper LA, Atz AM, Levine JC et al (2010) Enalapril in infants with single ventricle: Results of a multicenter randomized trial. Circulation 122(4):333–340
Januszewska K, Kozlik-Feldmann R, Dalla-Pozza R, Greil S, Abicht J, Netz H et al (2011) Right ventricle-to-pulmonary artery shunt related complications after Norwood procedure. Eur J Cardiothorac Surg 40(3):584–590
Mair R, Tulzer G, Sames E, Gitter R, Lechner E, Steiner J et al (2003) Right ventricular to pulmonary artery conduit instead of modified blalock-taussig shunt improves postoperative hemodynamics in newborns after the Norwood operation. J Thorac Cardiovasc Surg 126(5):1378–1384
Margossian R, Schwartz ML, Prakash A, Wruck L, Colan SD, Atz AM et al (2009) Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the Pediatric Heart Network Fontan Cross-Sectional Study). Am J Cardiol 104(3):419–428
Menon SC, Minich LL, Casper TC, Puchalski MD, Hawkins JA, Tani LY (2011) Regional myocardial dysfunction following Norwood with right ventricle to pulmonary artery conduit in patients with hypoplastic left heart syndrome. J Am Soc Echocardiogr 24(8):826–833
Montgomery J, Henderson M, Ostrowsky J, Karimi M, Hennein H (2010) Repair of ventricular aneurysm after stage I modified Sano-Norwood procedure. Crit Care Nurse 30(2):54–59
Ohye RG, Ludomirsky A, Devaney EJ, Bove EL (2004) Comparison of right ventricle to pulmonary artery conduit and modified Blalock-Taussig shunt hemodynamics after the Norwood operation. Ann Thorac Surg 78(3):1090–1093
Padalino MA, Castellani C, Toffoli S, Della Barbera M, Milanesi O, Thiene G et al (2008) Pathological changes and myocardial remodelling related to the mode of shunting following surgical palliation for hypoplastic left heart syndrome. Cardiol Young 18(4):415–422
Pizarro C, Malec E, Maher KO, Januszewska K, Gidding SS, Murdison KA, et al. (2003) Right ventricle to pulmonary artery conduit improves outcome after stage I Norwood for hypoplastic left heart syndrome. Circulation 108(Suppl 1):II155–II160
Sano S, Ishino K, Kawada M, Arai S, Kasahara S, Asai T et al (2003) Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 126(2):504–549
Sano S, Ishino K, Kawada M, Honjo O (2004) Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. Semin Thorac Cardiovasc Surg Pediatr Cardiol Surg Annu 7:22–31
Shin SH, Hung CL, Uno H, Hassanein AH, Verma A, Bourgoun M et al (2010) Mechanical dyssynchrony after myocardial infarction in patients with left ventricular dysfunction, heart failure, or both. Circulation 121:1096–1103
Sluysmans T, Colan SD (2005) Theoretical and empirical derivation of cardiovascular allometric relationships in children. J Appl Physiol 99(2):445–457
Takabayashi S, Shimpo H, Yokoyama K, Onoda K, Mitani Y (2007) Reduced regional right ventricular wall motion after transventricular repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 133(6):1656–1658
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Menon, S.C., Erickson, L.K., McFadden, M. et al. Effect of Ventriculotomy on Right-Ventricular Remodeling in Hypoplastic Left Heart Syndrome: A Histopathological and Echocardiography Correlation Study. Pediatr Cardiol 34, 354–363 (2013). https://doi.org/10.1007/s00246-012-0462-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-012-0462-x