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Systemic Ventricular Dysfunction Between Stage One and Stage Two Palliation
Thomas J Kulik1,2,3,4, Lynn A Sleeper5,6, Christina VanderPluym5,6
1Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA. thomas.kulik@cardio.chboston.org.
Pediatric Cardiology
|June 28, 2018
Summary
Systemic ventricular dysfunction (SVD) affects 12% of infants after stage 1 heart surgery. While often resolving, SVD impacts outcomes, with potential links to chronic ischemia.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Single ventricle physiology presents unique challenges in pediatric cardiac care.
- Systemic ventricular dysfunction (SVD) is a known complication post-stage 1 palliation, but data is limited.
Purpose of the Study:
- To investigate the incidence, predictors, and outcomes of SVD in infants undergoing stage 1 palliation.
- To explore the potential role of myocardial histology in SVD development and resolution.
Main Methods:
- Retrospective cohort study of 267 infants undergoing stage 1 operations (Norwood, Sano, or hybrid).
- Analysis of outcomes between stages 1 and 2, including survival and subsequent surgeries.
- Histological examination of explanted hearts from transplanted patients.
Main Results:
- SVD developed in 12% of patients, with 41% resolving.
- No significant predictors for SVD onset were identified (e.g., cardiac anatomy, procedure type, weight).
- Patients with SVD resolution had outcomes comparable to those without SVD; myocardial histology suggested chronic ischemia.
Conclusions:
- SVD is a potential complication after stage 1 palliation, occurring in both systemic RV and LV.
- Resolution of SVD is possible, and outcomes may be favorable in those with resolution.
- Further multi-center studies are needed to identify predictors and understand the pathophysiology of SVD.
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