Clinical InvestigationEchocardiography in ChildrenTricuspid Regurgitation in Hypoplastic Left Heart Syndrome: Three-Dimensional Echocardiography Provides Additional Information in Describing Jet Location
Section snippets
Methods
A retrospective study was performed among all patients with HLHS managed at a quaternary-level pediatric cardiac surgical center in Canada between January 1, 2005, and June 30, 2016. The interprovincial centralized database, 3DE and 2DE databases, hospital records, and clinical charts were reviewed. Subjects meeting the inclusion criteria were patients with HLHS who had mild or greater TR and had undergone 2DE and 3DE within 2 weeks of each other. Those patients who underwent TV surgery were
Results
From January 2005 to December 2016, 57 patients with HLHS met the inclusion criteria. Of the 57 patients, one had inadequate 3D echocardiographic images for analysis and was excluded from the study (feasibility of 3DE 98%). All patients had adequate 2D echocardiographic images for interpretation (feasibility of 2DE 100%). Fifty-four patients had adequate transthoracic echocardiograms (2DE and 3DE), and two patients had transesophageal echocardiograms (2DE and 3DE) for analysis in the study.
Discussion
The main findings of this study in patients with HLHS are that assessment of TR location on 2DE has poor agreement with TR location on 3DE. In addition, assessment of TR jet location on 2DE was poorly reproducible, which challenges the usefulness of 2DE for surgical planning beyond simple assessment of TV annular size and qualitative TR severity. In contrast, TR jet location on 3DE was highly reproducible.
Conclusion
In children with HLHS, assessment of TR location on 2DE has poor agreement with TR location on 3DE and was poorly reproducible. In contrast, TR jet location on 3DE was highly reproducible and is likely to provide reliable preoperative information on jet location for surgical planning. A single, central TR jet was the most common in patients with HLHS pre-Glenn, while post-Glenn TR occurred equally in the center (where all the leaflets meet) and at the AS closure line, highlighting the potential
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This study was generously sponsored by the Stollery Children's Hospital Foundation through the Women and Children's Health Research Institute.
Conflicts of interest: None.