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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.

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Summary
This summary is machine-generated.

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.

Keywords:
CardiomyopathyHypoplastic left heart syndromeNorwoodSanoVentricular dysfunction

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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.