Related Experiment Video
Updated: Feb 28, 2026
Author Spotlight: Establishment and Confirmation of a Postnatal Right Ventricular Volume Overload Mouse Model
Published on: June 9, 2023
Pulmonary Vein Doppler Patterns in Infants with Single Right Ventricle Anomalies After Initial Staged Palliations
Edward C Kirkpatrick1,2, Jessica Steltzer3, Pippa Simpson4
1Children's Hospital of Wisconsin, Medical College of Wisconsin, 9000 W. Wisconsin Ave, Milwaukee, WI, 53226, USA. ekirkpatrick@chw.org.
Insights
Pulmonary vein flow (PVF) patterns in single right ventricle (RV) infants show a dominant systolic pattern post-Norwood palliation. These patterns evolve over time and differ based on initial shunt type, but do not correlate with clinical outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Infants with single right ventricle (RV) anomalies often undergo staged palliation, significantly altering hemodynamics.
- Pulmonary vein flow (PVF) patterns are sensitive indicators of cardiac function and filling dynamics.
Purpose of the Study:
- To describe serial changes in echocardiographic Doppler PVF patterns in infants with single RV.
- To compare PVF patterns based on initial surgical shunt type and their relationship to clinical outcomes.
Main Methods:
- Serial echocardiographic Doppler measurements of PVF (peak velocities, VTIs, S/D ratios, Ar waves) were performed in 261 infants post-Norwood palliation.
- Data were collected at early post-Norwood, pre-stage II surgery, and 14 months.
- PVF indices were analyzed over time, between modified Blalock-Taussig shunt (MBTS) and right ventricle-to-pulmonary artery shunt (RVPAS) groups, and correlated with clinical outcomes.
Main Results:
- PVF demonstrated a dominant systolic pattern throughout infancy, differing from normal infants.
- Systolic velocities and VTIs increased over time, while diastolic components remained stable, leading to increasing S/D ratios (1.14 to 1.89, P < 0.0001).
- MBTS group showed higher S/D ratios compared to RVPAS initially, but these differences resolved by 14 months. PVF patterns did not correlate with survival or hospitalization.
Conclusions:
- PVF patterns in single RV infants evolve significantly from the early post-Norwood period to cavopulmonary connection.
- Initial shunt type influences early PVF dynamics, but these differences normalize over time.
- PVF patterns in this cohort do not predict clinical outcomes, suggesting other factors are more influential.
Abstract:
The aim of this study was to describe serial changes in echocardiographic Doppler pulmonary vein flow (PVF) patterns in infants with single right ventricle (RV) anomalies enrolled in the Single Ventricle Reconstruction trial. Measurement of PVF peak systolic (S) and diastolic (D) velocities, velocity time integrals (VTI), S/D peak velocity and VTI ratios, and frequency of atrial reversal (Ar) waves were made at three postoperative time points in 261 infants: early post-Norwood, pre-stage II surgery, and 14 months. Indices were compared over time, between initial shunt type [modified Blalock-Taussig shunt (MBTS) and right ventricle-to-pulmonary artery shunt (RVPAS)] and in relation to clinical outcomes. S velocities and VTI increased over time while D wave was stable, resulting in increasing S/D peak velocity and VTI ratios, with a median post-Norwood S/D VTI ratio of 1.14 versus 1.38 at pre-stage II and 1.89 at 14 months (P < 0.0001 between intervals). MBTS subjects had significantly higher S/D peak velocity and VTI ratios compared to RVPAS at the post-Norwood and pre-stage II time points (P < 0.0001) but not by 14 months. PVF patterns did not correlate with survival or hospitalization course at 1 year. PVF patterns after Norwood palliation differ from normal infants by having a dominant systolic pattern throughout infancy. PVF differences based upon shunt type resolve by 14 months and did not correlate with clinical outcomes. This study describes normative values and variations in PVF for infants with a single RV from shunt-dependent pulmonary blood flow to cavopulmonary blood flow.
