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Pulmonary Vein Doppler Patterns in Infants with Single Right Ventricle Anomalies After Initial Staged Palliations

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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.

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Acknowledgements

The authors would like to thank David Saudek M.D. for being one of the echocardiography reviewers for this study.

Funding

There was no funding provided for this study.

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Authors and Affiliations

  1. Children’s Hospital of Wisconsin, Medical College of Wisconsin, 9000 W. Wisconsin Ave, Milwaukee, WI, 53226, USA

    Edward C. Kirkpatrick, Jessica Steltzer & Peter Frommelt

  2. Department of Pediatrics, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA

    Pippa Simpson & Amy Pan

  3. Toronto Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada

    Andrea Dragulescu

  4. Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Christine B. Falkensammer

  5. University of Michigan, 1540 E Hospital Dr, Ann Arbor, MI, 48109, USA

    Sarah Gelehrter

  6. Children’s Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA

    Wyman W. Lai

  7. Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, USA

    Jami Levine

  8. Duke University, 2301 Erwin Rd, Durham, NC, 27710, USA

    Stephen Miller

  9. University of Utah, 100 Mario Capecchi Dr, Salt Lake City, UT, 84132, USA

    Thomas A. Miller

  10. Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA

    Jay Pruetz

  11. Emory University, 1405 Clifton Road NE, Atlanta, GA, 30322-1062, USA

    Ritu Sachdeva

  12. Nemours. Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA

    Deepika Thacker

  13. PO Box 1997, Milwaukee, WI, 53201, USA

    Edward C. Kirkpatrick

Authors
  1. Edward C. Kirkpatrick
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  2. Jessica Steltzer
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  3. Pippa Simpson
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  4. Amy Pan
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  5. Andrea Dragulescu
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  6. Christine B. Falkensammer
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  7. Sarah Gelehrter
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  8. Wyman W. Lai
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  9. Jami Levine
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  10. Stephen Miller
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  11. Thomas A. Miller
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  12. Jay Pruetz
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  13. Ritu Sachdeva
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  14. Deepika Thacker
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  15. Peter Frommelt
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Corresponding author

Correspondence to Edward C. Kirkpatrick.

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The authors do not have any conflicts of interest to disclose regarding this manuscript.

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Kirkpatrick, E.C., Steltzer, J., Simpson, P. et al. Pulmonary Vein Doppler Patterns in Infants with Single Right Ventricle Anomalies After Initial Staged Palliations. Pediatr Cardiol 38, 1288–1295 (2017). https://doi.org/10.1007/s00246-017-1660-3

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  • DOI: https://doi.org/10.1007/s00246-017-1660-3

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