Skip to main content
SpringerLink
Log in

Ventriculotomy Decreases Agreement Between Assessment of Right Ventricular Function by Echocardiography and Cardiac Magnetic Resonance Imaging in Patients with Hypoplastic Left Heart Syndrome

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Accurate assessment of the right ventricular (RV) volume and function is important in patients with hypoplastic left heart syndrome (HLHS). We sought to investigate the effect of ventriculotomy on the correlation of RV functional assessments by two-dimensional echocardiography (2DE) to cardiac magnetic resonance (CMR)-derived RV ejection fraction (EF) in patients with HLHS. A retrospective re-analysis of CMR imaging with matched 2DE was performed from the institutional HLHS registry. Echocardiographic RV functional parameters were analyzed and correlated with CMR-derived EF. Intraclass correlation coefficient was used to determine interobserver reliability. A total of 58 matched echocardiograms and CMR imaging studies from 46 patients was evaluated. Median duration between CMR imaging and echocardiogram was 1 day (range 0–6 days). No significant difference was seen in CMR RV EF between patients with and without a ventriculotomy (EF − 43.6% vs 44.7%, p = 0.85). The presence of a ventriculotomy significantly decreased the correlation of biplane FAC (r = 0.86 vs 0.52; p = 0.02), triplane FAC (r = 0.84 vs 0.49; p = 0.03), and 2DE visually estimated EF (r = 0.83 vs 0.49; p = 0.02). The correlation of circumferential and longitudinal strains to CMR-derived EF was not significantly affected by the presence of a ventriculotomy. A prior ventriculotomy significantly affected correlation between 2DE FAC and visually estimated EF with CMR-derived EF. The dyskinetic myocardial segment due to ventriculotomy, which is often not visualized by 2DE, may be the reason for this discrepancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

All data and materials within this manuscript are available upon request.

References

  1. Altmann K, Printz BF, Solowiejczky DE, Gersony WM, Quaegebeur J, Apfel HD (2000) Two-dimensional echocardiographic assessment of right ventricular function as a predictor of outcome in hypoplastic left heart syndrome. Am J Cardiol 86(9):964–968. https://doi.org/10.1016/s0002-9149(00)01131-0

    Article  CAS  PubMed  Google Scholar 

  2. Mertens LL, Friedberg MK (2010) Imaging the right ventricle–current state of the art. Nat Rev Cardiol 7(10):551–563. https://doi.org/10.1038/nrcardio.2010.118

    Article  PubMed  Google Scholar 

  3. Tsai-Goodman B, Geva T, Odegard KC, Sena LM, Powell AJ (2004) Clinical role, accuracy, and technical aspects of cardiovascular magnetic resonance imaging in infants. Am J Cardiol 94(1):69–74. https://doi.org/10.1016/j.amjcard.2004.03.033

    Article  PubMed  Google Scholar 

  4. Ho SY, Nihoyannopoulos P (2006) Anatomy, echocardiography, and normal right ventricular dimensions. Heart 92(Suppl 1):i2-13. https://doi.org/10.1136/hrt.2005.077875

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bellsham-Revell HR, Simpson JM, Miller OI, Bell AJ (2013) Subjective evaluation of right ventricular systolic function in hypoplastic left heart syndrome: how accurate is it? J Am Soc Echocardiogr 26(1):52–56. https://doi.org/10.1016/j.echo.2012.09.020

    Article  PubMed  PubMed Central  Google Scholar 

  6. Margossian R, Schwartz ML, Prakash A, Wruck L, Colan SD, Atz AM, Bradley TJ, Fogel MA, Hurwitz LM, Marcus E, Powell AJ, Printz BF, Puchalski MD, Rychik J, Shirali G, Williams R, Yoo SJ, Geva T, Pediatric Heart Network I (2009) Comparison of echocardiographic and cardiac magnetic resonance imaging measurements of functional single ventricular volumes, mass, and ejection fraction (from the pediatric heart network fontan cross-sectional study). Am J Cardiol 104(3):419–428. https://doi.org/10.1016/j.amjcard.2009.03.058

    Article  PubMed  PubMed Central  Google Scholar 

  7. Iriart X, Roubertie F, Jalal Z, Thambo JB (2016) Quantification of systemic right ventricle by echocardiography. Arch Cardiovasc Dis 109(2):120–127. https://doi.org/10.1016/j.acvd.2015.11.008

    Article  PubMed  Google Scholar 

  8. Khattab K, Schmidheiny P, Wustmann K, Wahl A, Seiler C, Schwerzmann M (2013) Echocardiogram versus cardiac magnetic resonance imaging for assessing systolic function of subaortic right ventricle in adults with complete transposition of great arteries and previous atrial switch operation. Am J Cardiol 111(6):908–913. https://doi.org/10.1016/j.amjcard.2012.11.044

    Article  PubMed  Google Scholar 

  9. Chow PC, Liang XC, Cheung EW, Lam WW, Cheung YF (2008) New two-dimensional global longitudinal strain and strain rate imaging for assessment of systemic right ventricular function. Heart 94(7):855–859. https://doi.org/10.1136/hrt.2007.131862

    Article  PubMed  Google Scholar 

  10. Petko C, Uebing A, Furck A, Rickers C, Scheewe J, Kramer HH (2011) Changes of right ventricular function and longitudinal deformation in children with hypoplastic left heart syndrome before and after the Norwood operation. J Am Soc Echocardiogr 24(11):1226–1232. https://doi.org/10.1016/j.echo.2011.08.016

    Article  PubMed  Google Scholar 

  11. Ohye RG, Sleeper LA, Mahony L, Newburger JW, Pearson GD, Lu M, Goldberg CS, Tabbutt S, Frommelt PC, Ghanayem NS, Laussen PC, Rhodes JF, Lewis AB, Mital S, Ravishankar C, Williams IA, Dunbar-Masterson C, Atz AM, Colan S, Minich LL, Pizarro C, Kanter KR, Jaggers J, Jacobs JP, Krawczeski CD, Pike N, McCrindle BW, Virzi L, Gaynor JW, Pediatric Heart Network I (2010) Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 362(21):1980–1992. https://doi.org/10.1056/NEJMoa0912461

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Pizarro C, Mroczek T, Malec E, Norwood WI (2004) Right ventricle to pulmonary artery conduit reduces interim mortality after stage 1 Norwood for hypoplastic left heart syndrome. Ann Thorac Surg 78(6):1959–1963. https://doi.org/10.1016/j.athoracsur.2004.06.020 (discussion 1963–1954)

    Article  PubMed  Google Scholar 

  13. Ling LF, Obuchowski NA, Rodriguez L, Popovic Z, Kwon D, Marwick TH (2012) Accuracy and interobserver concordance of echocardiographic assessment of right ventricular size and systolic function: a quality control exercise. J Am Soc Echocardiogr 25(7):709–713. https://doi.org/10.1016/j.echo.2012.03.018

    Article  PubMed  Google Scholar 

  14. Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, Lai WW, Geva T (2010) Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 23(5):465–495. https://doi.org/10.1016/j.echo.2010.03.019 (quiz 576–467)

    Article  PubMed  Google Scholar 

  15. Avitabile CM, Whitehead K, Fogel M, Mercer-Rosa L (2014) Tricuspid annular plane systolic excursion does not correlate with right ventricular ejection fraction in patients with hypoplastic left heart syndrome after Fontan palliation. Pediatr Cardiol 35(7):1253–1258. https://doi.org/10.1007/s00246-014-0924-4

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lipczynska M, Szymanski P, Kumor M, Klisiewicz A, Mazurkiewicz L, Hoffman P (2015) Global longitudinal strain may identify preserved systolic function of the systemic right ventricle. Can J Cardiol 31(6):760–766. https://doi.org/10.1016/j.cjca.2015.02.028

    Article  PubMed  Google Scholar 

  17. Diller GP, Radojevic J, Kempny A, Alonso-Gonzalez R, Emmanouil L, Orwat S, Swan L, Uebing A, Li W, Dimopoulos K, Gatzoulis MA, Baumgartner H (2012) Systemic right ventricular longitudinal strain is reduced in adults with transposition of the great arteries, relates to subpulmonary ventricular function, and predicts adverse clinical outcome. Am Heart J 163(5):859–866. https://doi.org/10.1016/j.ahj.2012.01.038

    Article  PubMed  Google Scholar 

  18. Brooks PA, Khoo NS, Mackie AS, Hornberger LK (2012) Right ventricular function in fetal hypoplastic left heart syndrome. J Am Soc Echocardiogr 25(10):1068–1074. https://doi.org/10.1016/j.echo.2012.06.005

    Article  PubMed  Google Scholar 

  19. Khoo NS, Smallhorn JF, Kaneko S, Myers K, Kutty S, Tham EB (2011) Novel insights into RV adaptation and function in hypoplastic left heart syndrome between the first 2 stages of surgical palliation. JACC Cardiovasc Imaging 4(2):128–137. https://doi.org/10.1016/j.jcmg.2010.09.022

    Article  PubMed  Google Scholar 

  20. Tham EB, Smallhorn JF, Kaneko S, Valiani S, Myers KA, Colen TM, Kutty S, Khoo NS (2014) Insights into the evolution of myocardial dysfunction in the functionally single right ventricle between staged palliations using speckle-tracking echocardiography. J Am Soc Echocardiogr 27(3):314–322. https://doi.org/10.1016/j.echo.2013.11.012

    Article  PubMed  Google Scholar 

  21. Pettersen E, Helle-Valle T, Edvardsen T, Lindberg H, Smith HJ, Smevik B, Smiseth OA, Andersen K (2007) Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 49(25):2450–2456. https://doi.org/10.1016/j.jacc.2007.02.062

    Article  PubMed  Google Scholar 

  22. Colquitt JL, Loar RW, Morris SA, Feagin DK, Sami S, Pignatelli RH (2019) Serial strain analysis identifies hypoplastic left heart syndrome infants at risk for cardiac morbidity and mortality: a pilot study. J Am Soc Echocardiogr 32(5):643–650. https://doi.org/10.1016/j.echo.2019.01.006

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported and funded by the Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome.

Funding

This study was funded by Todd and Karen Wanek Family Program for Hypoplastic Left Heart Syndrome.

Author information

Authors and Affiliations

  1. Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA

    Alan P. Wang, Patrick W. O’Leary & M. Yasir Qureshi

  2. Division of Pediatric Cardiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Angela M. Kelle, Chelsea L. Reece, Patrick W. O’Leary & M. Yasir Qureshi

  3. Division of Biostatistics, Mayo Clinic, Rochester, MN, USA

    Meredith Hyun

  4. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Phillip M. Young

  5. Division of Pediatric Cardiology, Department of Pediatrics, Penn State Hershey Medical Center, Hershey, PA, USA

    Angela M. Kelle

Authors
  1. Alan P. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angela M. Kelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Meredith Hyun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chelsea L. Reece
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Phillip M. Young
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patrick W. O’Leary
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Yasir Qureshi
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Wanek Family Program for Hypoplastic Left Heart Syndrome Imaging Pipeline

  • Timothy J. Nelson
  • , Dawit T. Haile
  • , Angela R. Miller
  • , Sara E. Martineau
  • , Amanda L. Breuer
  • , Karen S. Miller
  • , Lori A. Riess
  • , Karen M. Cavanaugh
  •  & Lucas Timmons

Corresponding author

Correspondence to M. Yasir Qureshi.

Ethics declarations

Conflict of interest

No financial disclosures or conflicts of interest.

Ethical Approval

This study is approved by Mayo Clinic Institutional Review Board.

Consent to Participate

Written informed consent to participate in the study was obtained from the parents for all participants under 18 years of age or the participants themselves if 18 years of age or above.

Consent for Publication

Written informed consent to publish the obtained data was obtained from the parents for all participants under 18 years of age or the participants themselves if 18 years of age or above.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, A.P., Kelle, A.M., Hyun, M. et al. Ventriculotomy Decreases Agreement Between Assessment of Right Ventricular Function by Echocardiography and Cardiac Magnetic Resonance Imaging in Patients with Hypoplastic Left Heart Syndrome. Pediatr Cardiol 42, 951–959 (2021). https://doi.org/10.1007/s00246-021-02569-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-021-02569-2

Keywords

Search

Navigation