Clinical InvestigationsEchocardiography in Infant Congenital Heart DiseaseAssociation of Bulboventricular Foramen Size and Need for Early Intervention in Infants with Tricuspid Atresia or Double-Inlet Left Ventricle with Normally Related Great Arteries
Section snippets
Methods
A retrospective, single-center study was conducted at Vanderbilt University Medical Center to determine indexed BVFA (iBVFA) size and patient outcomes. Patients chosen for inclusion had TA or DILV with normally related great arteries, with transthoracic echocardiography performed in the neonatal period from 2005 to 2021. Neonates with TA or DILV with pulmonary atresia were excluded. iBVFA measurements were performed by cardiologists blinded to patient outcomes. To evaluate interobserver
Results
Forty patients with TA or DILV with normally related great arteries were identified from 2005 to 2021. Three patients were excluded from analysis: two (one with TA, one with DILV) died before the Glenn operation from causes that were assumed unrelated to their cardiac diagnoses, and one (with TA) was lost to follow-up. Among the 37 patients included in the analysis, 30 had TA and seven had DILV. Table 1 describes the characteristics of the 37 patients included in the analysis. There were no
Discussion
Echocardiographic measurements of iBVFA in patients with TA or DILV with TGA to determine the adequacy of systemic output have been previously reported.1 In this study we characterized iBVFA and its relation to postnatal course and the need for intervention in patients with TA or DILV with normally related great arteries before the Glenn operation (in the form of a BTTS or PDA stent). Among our cohort, 73% underwent BTTS or PDA stent placement before the Glenn operation, and those with TA were
Conclusion
An iBVFA of ≤1.8 cm2/m2 on initial postnatal echocardiography is associated with the development of subpulmonary obstruction requiring intervention with a BTTS or PDA stent before the Glenn operation, with the highest risk patients having iBVFA of ≤1 cm2/m2. Factors such as pulmonary valve size and evidence of flow acceleration across the BVF and/or pulmonary outflow tract may be helpful in the decision algorithm to determine which patients at intermediate risk may require intervention to
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Imaging of Double Inlet Left Ventricle
2024, Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual
Conflicts of interest: None.