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Identification of patient variables that are associated with ventricular end-diastolic pressure before the bidirectional Glenn operation

Part of: Functionally Univentricular Heart Interventional Cardiology

Published online by Cambridge University Press:  09 March 2021

Matthew C. Schwartz Open the ORCID record for Matthew C. Schwartz [Opens in a new window] ,
Aravinth Karunanandaa ,
William E. Anderson ,
J. Rene Herlong ,
Joseph Paolillo ,
Gonzalo Wallis ,
Paul Kirshbom  and
Thomas S. Maxey
Matthew C. Schwartz*
Affiliation:
Sanger Heart and Vascular Institute, Charlotte, NC, USA Levine Children’s Hospital, Charlotte, NC, USA
Aravinth Karunanandaa
Affiliation:
Levine Children’s Hospital, Charlotte, NC, USA
William E. Anderson
Affiliation:
Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC, USA
J. Rene Herlong
Affiliation:
Sanger Heart and Vascular Institute, Charlotte, NC, USA Levine Children’s Hospital, Charlotte, NC, USA
Joseph Paolillo
Affiliation:
Sanger Heart and Vascular Institute, Charlotte, NC, USA Levine Children’s Hospital, Charlotte, NC, USA
Gonzalo Wallis
Affiliation:
Sanger Heart and Vascular Institute, Charlotte, NC, USA Levine Children’s Hospital, Charlotte, NC, USA
Paul Kirshbom
Affiliation:
Sanger Heart and Vascular Institute, Charlotte, NC, USA Levine Children’s Hospital, Charlotte, NC, USA
Thomas S. Maxey
Affiliation:
Sanger Heart and Vascular Institute, Charlotte, NC, USA Levine Children’s Hospital, Charlotte, NC, USA
*
Author for correspondence: Matthew C. Schwartz, MD, Atrium Health, Sanger Heart and Vascular Institute, Levine Children’s Hospital, 1001 Blythe Blvd, Suite 200D, Charlotte, NC, 28203, USA. Tel: +1 704 373 1812; Fax: +1 704 342 5871. E-mail: Matthew.c.schwartz@atriumhealth.org
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Abstract

Introduction:

Systemic ventricular end-diastolic pressure is important in patients with single ventricle heart disease. Predictors of an elevated systemic ventricular end-diastolic pressure prior to bidirectional Glenn operation have been incompletely identified.

Methods:

All patients who underwent bidirectional Glenn operation operation at our centre between January 2007 and March 2017 were retrospectively identified and patient variables were extracted. For patients who had undergone Fontan operation at the time of this study, post-Fontan patient variables were also extracted.

Results:

One-hundred patients were included with a median age at pre-bidirectional Glenn operation catheterisation of 4.5 months. In total, 71 (71%) patients had a systemic right ventricle. At the pre-bidirectional Glenn operation catheterisation, the mean systemic ventricular end-diastolic pressure was higher amongst those with systemic right ventricle compared to left ventricle (9.1 mmHg ± 2.1 versus 7.7 ± 2.7 mmHg, p < 0.01). On univariate analysis, pre-bidirectional Glenn operation systemic ventricular end-diastolic pressure was positively associated with the presence of a systemic right ventricle (p < 0.01), history of recoarctation (p = 0.03), history of Norwood operation (p = 0.04), and ventricular systolic pressure (p < 0.01). On multivariate analysis, systemic ventricular end-diastolic pressure was positively associated with the presence of a systemic right ventricle (p < 0.01) and ventricular systolic pressure (p < 0.01). Amongst those who had undergone Fontan operation at the time of study (n = 49), those with a higher pre-bidirectional Glenn operation systemic ventricular end-diastolic pressure were more likely to have experienced death, transplantation, or listed for transplantation (p = 0.02) and more likely to have had heart failure symptoms (p = 0.04) at a mean time from Fontan of 5.2 years ± 1.3.

Conclusions:

In patients undergoing bidirectional Glenn operation operation, the volume-loaded, pre-bidirectional Glenn operation state may expose diastolic dysfunction that has prognostic value.

Keywords

Single ventricleend-diastolic pressureFontan
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 10 , October 2021 , pp. 1644 - 1650
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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