Neo-aortic insufficiency late after staged reconstruction for hypoplastic left heart syndrome: impact of differences in initial palliative procedures.

Authors:
Kentaro Umezu
Kentaro Umezu
Nagano Children's Hospital
Japan
Yorikazu Harada
Yorikazu Harada
Nagano Children's Hospital
Nagano | Japan
Takahiko Sakamoto
Takahiko Sakamoto
The Heart Institute of Japan
Toru Okamura
Toru Okamura
Tokyo Women's Medical University
Japan
Shizuya Shintomi
Shizuya Shintomi
Tokyo Women's Medical University
Japan
Kiyohiro Takigiku
Kiyohiro Takigiku
Nagano Children's Hospital
Japan
Satoshi Yasukochi
Satoshi Yasukochi
Nagano Children's Hospital
Japan

Heart Vessels 2019 Mar 27. Epub 2019 Mar 27.

Department of Pediatric Cardiology, Nagano Children's Hospital, Nagano, Japan.

The neo-aortic insufficiency in patients with hypoplastic left heart syndrome is an important sequela. We assessed the risks of the neo-aortic valve deterioration by the difference of initial palliations: Group I underwent primary Norwood (Nw) with systemic-to-pulmonary artery shunt (SPS), Group II underwent bilateral pulmonary artery banding (bPAB) and subsequent Nw with SPS (bPAB-Nw/SPS), Group III underwent bPAB and subsequent Nw with bidirectional Glenn (BDG) procedure (bPAB-Nw/BDG). The neo-aortic valve z score changes over time did not reach statistical significance in all groups (p = 0.43 for Group I, 0.20 for Group II, and 0.30 for Group III). The degree of neo-aortic valve insufficiency did not change significantly over time during this period except for Group III (p = 0.34 for Group I, 0.20 for Group II, and 0.02 for Group III). On the other hand, dimensions of the neo-aortic annulus and degrees of neo-aortic insufficiency did not differ significantly among the 3 groups at any pre-determined time. The presence or absence of incision into the sino-tubular junction at Nw did not affect the late neo-aortic valve z score or insufficiency. These data indicate that the difference of initial palliative procedures does not affect late neo-aortic valve insufficiency in Nw survivors. Because valve failure may develop in longer follow-up, further observation should be conducted.

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http://dx.doi.org/10.1007/s00380-019-01376-3DOI Listing
March 2019
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