Amelogenesis imperfecta, hypoplastic type - Dr Sanjana Ravindra
Inter-stage right ventricular remodeling in hypoplastic left heart syndrome
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POSTER PRESENTATION Open Access Inter-stage right ventricular remodeling in hypoplastic left heart syndrome Aaron Bell 1 , Hannah R Bellsham-Revell 2* , Philipp Beerbaum 2 , Reza Razavi 2 , Gerald Greil 2 From 2011 SCMR/Euro CMR Joint Scientific Sessions Nice, France. 3-6 February 2011 Background Magnetic resonance imaging (MRI) can be used as a means of pre-operative evaluation of the cardiac anatomy and function in patients with hypoplastic left heart syn- drome (HLHS) prior to superior and total cavo-pulmonary connection (TCPC). Serial MRI evaluation prior to each cavo-pulmonary palliation allows us to demonstrate the remodelling of the right ventricle. Methods A retrospective analysis of the serial MRI scans of all patients with HLHS who had undergone palliation through to completion of Fontan was undertaken. Re-analysis was undertaken by two members of the research team who had previously shown good intrauser variability. Ethical and institutional approval was obtained. All scans had been performed with general anaesthesia on a Philips 1.5 Tesla Intera MRI scanner. Results 51 patients had undergone completion of Fontan and had MRI scans performed prior to each cavo-pulmon- ary connection available for analysis. Median (range) age in years at the first MRI, superior cavopulmonary connection, pre-TCPC MRI and TCPC was 0.44 (0.12-1.02), 0.57 (0.13-1.37), 2.80 (1.80-5.52), 3.26 (2.28-6.76) respectively. Right ventricular (RV) volumes indexed to body surface area are demon- strated in table 1. There was a marked reduction in indexed RV end diastolic volume (iEDV), indexed RV end systolic volume (iESV). Indexed stroke volume (iSV) remained constant, but indexed cardiac output (iCO) fell, likely due to the decrease in heart rate (HR) between the two scans. There was an increase in global ejection fraction (EF). Conclusions The right ventricle undergoes significant remodelling between palliative stages. Reduction in the volume loading by replacing a shunt dependent circulation with a cavo-pulmonary connection significantly alters right ventricular volumes and improves function. 2 King’s College London, London, UK Full list of author information is available at the end of the article Table 1 Heart Rate median (range) iEDV (ml/m2) median (range) iESV median (range) iSV median (range) iCO median (range) EF median (range) MRI prior to superior cavo-pulmonary connection 115 (83-150) 91.90 (48.67-213.63) 45.13 (15.31-126.5) 47.33 (19.91-105.77) 5.12 (2.49-13.36) 51.4 (28.4-72.4) MRI prior to total cavo-pulmonary connection 85 (57-133) 84.45 (46.42-152.10) 36.12 (14.38-64.97) 48.02 (32.02-98.73) 4.15 (3.01-8.20) 59 (43.2-76.2) Bell et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P205 http://jcmr-online.com/content/13/S1/P205 © 2011 Bell et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Transcript of Inter-stage right ventricular remodeling in hypoplastic left heart syndrome
POSTER PRESENTATION Open Access
Inter-stage right ventricular remodeling inhypoplastic left heart syndromeAaron Bell1, Hannah R Bellsham-Revell2*, Philipp Beerbaum2, Reza Razavi2, Gerald Greil2
From 2011 SCMR/Euro CMR Joint Scientific SessionsNice, France. 3-6 February 2011
BackgroundMagnetic resonance imaging (MRI) can be used as ameans of pre-operative evaluation of the cardiac anatomyand function in patients with hypoplastic left heart syn-drome (HLHS) prior to superior and total cavo-pulmonaryconnection (TCPC). Serial MRI evaluation prior to eachcavo-pulmonary palliation allows us to demonstrate theremodelling of the right ventricle.
MethodsA retrospective analysis of the serial MRI scans of allpatients with HLHS who had undergone palliationthrough to completion of Fontan was undertaken.Re-analysis was undertaken by two members of theresearch team who had previously shown good intrauservariability. Ethical and institutional approval was obtained.All scans had been performed with general anaesthesia ona Philips 1.5 Tesla Intera MRI scanner.
Results51 patients had undergone completion of Fontan andhad MRI scans performed prior to each cavo-pulmon-
ary connection available for analysis. Median (range)age in years at the first MRI, superior cavopulmonaryconnection, pre-TCPC MRI and TCPC was 0.44(0.12-1.02), 0.57 (0.13-1.37), 2.80 (1.80-5.52), 3.26(2.28-6.76) respectively. Right ventricular (RV)volumes indexed to body surface area are demon-strated in table 1. There was a marked reduction inindexed RV end diastolic volume (iEDV), indexed RVend systolic volume (iESV). Indexed stroke volume(iSV) remained constant, but indexed cardiac output(iCO) fell, likely due to the decrease in heart rate(HR) between the two scans. There was an increase inglobal ejection fraction (EF).
ConclusionsThe right ventricle undergoes significant remodellingbetween palliative stages. Reduction in the volumeloading by replacing a shunt dependent circulationwith a cavo-pulmonary connection significantlyalters right ventricular volumes and improvesfunction.
2King’s College London, London, UKFull list of author information is available at the end of the article
Table 1
Heart Ratemedian (range)
iEDV (ml/m2)median (range)
iESV median (range) iSV median (range) iCO median(range)
EF median(range)
MRI prior to superiorcavo-pulmonaryconnection
115 (83-150) 91.90 (48.67-213.63) 45.13 (15.31-126.5) 47.33 (19.91-105.77) 5.12 (2.49-13.36) 51.4 (28.4-72.4)
MRI prior to totalcavo-pulmonaryconnection
85 (57-133) 84.45 (46.42-152.10) 36.12 (14.38-64.97) 48.02 (32.02-98.73) 4.15 (3.01-8.20) 59 (43.2-76.2)
Bell et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P205http://jcmr-online.com/content/13/S1/P205
© 2011 Bell et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.
Author details1Guy’s and St Thomas’ Foundation NHS Trust, London, UK. 2King’s CollegeLondon, London, UK.
Published: 2 February 2011
doi:10.1186/1532-429X-13-S1-P205Cite this article as: Bell et al.: Inter-stage right ventricular remodeling inhypoplastic left heart syndrome. Journal of Cardiovascular MagneticResonance 2011 13(Suppl 1):P205.
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Bell et al. Journal of Cardiovascular Magnetic Resonance 2011, 13(Suppl 1):P205http://jcmr-online.com/content/13/S1/P205
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