Significance of low peak doppler velocity in the proximal sano conduit in hypoplastic left heart syndrome

Shyam Sathanandam, Ranjit Philip, Andrew Van Bergen, David A. Roberson, Wei Cui, Michel N. Ilbawi, Alexander J. Javois, Tarek S. Husayni

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Abstract

Background. The Sano modification of the Norwoodoperation is a well-established first step palliation forhypoplastic left heart syndrome (HLHS). Theoretically,the first point of resistance to pulmonary flow should bein the proximal Sano, generating high Doppler flow velocity.Paradoxically, however, some patients have lowgradients in the proximal Sano conduit. The objective ofthis study was to determine the hemodynamic andanatomic significance of low proximal Sano Doppler flowvelocity and its clinical implications.

Methods. Doppler-derived peak gradients in the proximalSano conduits were measured in HLHS patientsafter Norwood-Sano surgery over a 4-year period andconfirmed by cardiac catheterization within 2 to 4 weeks.Clinical outcomes of patients with proximal Sano gradientsof 30 mm Hg or less (group 1) were compared withpatients whose gradient was greater than 30 mm Hg(group 2).

Results. Of the 53 patients, 21 (40%) belonged to group1. Patients in group 1 had smaller ostial right and leftpulmonary artery (PA) diameter (3.2 ± 1.2 mm versus 4.5 ±1.8 mm, p [ 0.03; and 3.4 ± 1.2 mm versus 5.6 ± 2.1 mm,p [ 0.01) when compared with patients in group 2. Patients(7 of 10) who needed either balloon angioplasty of adistal Sano or proximal branch PA were from group 1(p [ 0.01). Patients in group 1 had higher rates of unintendedPA interventions (33% versus 9%) and complications(48% versus 16%) compared with group 2.

Conclusions. Low peak Doppler flow velocity in theproximal Sano correlates with the presence of eitherdistal Sano stenosis or proximal branch PA stenosis.These patients require close follow-up in the interstageperiod and may need earlier intervention.

Original languageEnglish (US)
Pages (from-to)1378-1385
Number of pages8
JournalAnnals of Thoracic Surgery
Volume98
Issue number4
DOIs
StatePublished - Jan 1 2014

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Hypoplastic Left Heart Syndrome
Pathologic Constriction
Balloon Angioplasty
Cardiac Catheterization
Arteries
Hemodynamics
Lung

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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Significance of low peak doppler velocity in the proximal sano conduit in hypoplastic left heart syndrome. / Sathanandam, Shyam; Philip, Ranjit; Van Bergen, Andrew; Roberson, David A.; Cui, Wei; Ilbawi, Michel N.; Javois, Alexander J.; Husayni, Tarek S.

In: Annals of Thoracic Surgery, Vol. 98, No. 4, 01.01.2014, p. 1378-1385.

Research output: Contribution to journalArticle

Sathanandam, S, Philip, R, Van Bergen, A, Roberson, DA, Cui, W, Ilbawi, MN, Javois, AJ & Husayni, TS 2014, 'Significance of low peak doppler velocity in the proximal sano conduit in hypoplastic left heart syndrome', Annals of Thoracic Surgery, vol. 98, no. 4, pp. 1378-1385. https://doi.org/10.1016/j.athoracsur.2014.05.049
Sathanandam, Shyam ; Philip, Ranjit ; Van Bergen, Andrew ; Roberson, David A. ; Cui, Wei ; Ilbawi, Michel N. ; Javois, Alexander J. ; Husayni, Tarek S. / Significance of low peak doppler velocity in the proximal sano conduit in hypoplastic left heart syndrome. In: Annals of Thoracic Surgery. 2014 ; Vol. 98, No. 4. pp. 1378-1385.
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abstract = "Background. The Sano modification of the Norwoodoperation is a well-established first step palliation forhypoplastic left heart syndrome (HLHS). Theoretically,the first point of resistance to pulmonary flow should bein the proximal Sano, generating high Doppler flow velocity.Paradoxically, however, some patients have lowgradients in the proximal Sano conduit. The objective ofthis study was to determine the hemodynamic andanatomic significance of low proximal Sano Doppler flowvelocity and its clinical implications.Methods. Doppler-derived peak gradients in the proximalSano conduits were measured in HLHS patientsafter Norwood-Sano surgery over a 4-year period andconfirmed by cardiac catheterization within 2 to 4 weeks.Clinical outcomes of patients with proximal Sano gradientsof 30 mm Hg or less (group 1) were compared withpatients whose gradient was greater than 30 mm Hg(group 2).Results. Of the 53 patients, 21 (40{\%}) belonged to group1. Patients in group 1 had smaller ostial right and leftpulmonary artery (PA) diameter (3.2 ± 1.2 mm versus 4.5 ±1.8 mm, p [ 0.03; and 3.4 ± 1.2 mm versus 5.6 ± 2.1 mm,p [ 0.01) when compared with patients in group 2. Patients(7 of 10) who needed either balloon angioplasty of adistal Sano or proximal branch PA were from group 1(p [ 0.01). Patients in group 1 had higher rates of unintendedPA interventions (33{\%} versus 9{\%}) and complications(48{\%} versus 16{\%}) compared with group 2.Conclusions. Low peak Doppler flow velocity in theproximal Sano correlates with the presence of eitherdistal Sano stenosis or proximal branch PA stenosis.These patients require close follow-up in the interstageperiod and may need earlier intervention.",
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T1 - Significance of low peak doppler velocity in the proximal sano conduit in hypoplastic left heart syndrome

AU - Sathanandam, Shyam

AU - Philip, Ranjit

AU - Van Bergen, Andrew

AU - Roberson, David A.

AU - Cui, Wei

AU - Ilbawi, Michel N.

AU - Javois, Alexander J.

AU - Husayni, Tarek S.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background. The Sano modification of the Norwoodoperation is a well-established first step palliation forhypoplastic left heart syndrome (HLHS). Theoretically,the first point of resistance to pulmonary flow should bein the proximal Sano, generating high Doppler flow velocity.Paradoxically, however, some patients have lowgradients in the proximal Sano conduit. The objective ofthis study was to determine the hemodynamic andanatomic significance of low proximal Sano Doppler flowvelocity and its clinical implications.Methods. Doppler-derived peak gradients in the proximalSano conduits were measured in HLHS patientsafter Norwood-Sano surgery over a 4-year period andconfirmed by cardiac catheterization within 2 to 4 weeks.Clinical outcomes of patients with proximal Sano gradientsof 30 mm Hg or less (group 1) were compared withpatients whose gradient was greater than 30 mm Hg(group 2).Results. Of the 53 patients, 21 (40%) belonged to group1. Patients in group 1 had smaller ostial right and leftpulmonary artery (PA) diameter (3.2 ± 1.2 mm versus 4.5 ±1.8 mm, p [ 0.03; and 3.4 ± 1.2 mm versus 5.6 ± 2.1 mm,p [ 0.01) when compared with patients in group 2. Patients(7 of 10) who needed either balloon angioplasty of adistal Sano or proximal branch PA were from group 1(p [ 0.01). Patients in group 1 had higher rates of unintendedPA interventions (33% versus 9%) and complications(48% versus 16%) compared with group 2.Conclusions. Low peak Doppler flow velocity in theproximal Sano correlates with the presence of eitherdistal Sano stenosis or proximal branch PA stenosis.These patients require close follow-up in the interstageperiod and may need earlier intervention.

AB - Background. The Sano modification of the Norwoodoperation is a well-established first step palliation forhypoplastic left heart syndrome (HLHS). Theoretically,the first point of resistance to pulmonary flow should bein the proximal Sano, generating high Doppler flow velocity.Paradoxically, however, some patients have lowgradients in the proximal Sano conduit. The objective ofthis study was to determine the hemodynamic andanatomic significance of low proximal Sano Doppler flowvelocity and its clinical implications.Methods. Doppler-derived peak gradients in the proximalSano conduits were measured in HLHS patientsafter Norwood-Sano surgery over a 4-year period andconfirmed by cardiac catheterization within 2 to 4 weeks.Clinical outcomes of patients with proximal Sano gradientsof 30 mm Hg or less (group 1) were compared withpatients whose gradient was greater than 30 mm Hg(group 2).Results. Of the 53 patients, 21 (40%) belonged to group1. Patients in group 1 had smaller ostial right and leftpulmonary artery (PA) diameter (3.2 ± 1.2 mm versus 4.5 ±1.8 mm, p [ 0.03; and 3.4 ± 1.2 mm versus 5.6 ± 2.1 mm,p [ 0.01) when compared with patients in group 2. Patients(7 of 10) who needed either balloon angioplasty of adistal Sano or proximal branch PA were from group 1(p [ 0.01). Patients in group 1 had higher rates of unintendedPA interventions (33% versus 9%) and complications(48% versus 16%) compared with group 2.Conclusions. Low peak Doppler flow velocity in theproximal Sano correlates with the presence of eitherdistal Sano stenosis or proximal branch PA stenosis.These patients require close follow-up in the interstageperiod and may need earlier intervention.

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