Thorac Cardiovasc Surg 2023; 71(S 02): S73-S106
DOI: 10.1055/s-0043-1761902
Tuesday, 14 February
Joint Session DGPK/DGTHG: Was noch nicht besprochen wurde, aber dennoch wichtig ist!

Coronary Blood Supply of Patients with Hypoplastic Left Heart Syndrome

K. Will
1   Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
,
H. Stern
1   Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
,
N. Shehu
1   Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
,
B. Reich
1   Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
,
S. Martinoff
2   Radiologie, Deutsches Herzzentrum München, München, Deutschland
,
P. Ewert
1   Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
,
C. Meierhofer
1   Angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, München, Deutschland
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Background: Hypoplastic left heart syndrome (HLHS) is a complex cardiac underdevelopment of the left sided part of the heart resulting in a very small left ventricle causing hemodynamic insufficiency. Patients suffering from this condition are treated with a staged surgery (Norwood I or hybrid, PCPC or Comprehensive Stage II, TCPC). The right ventricle serves as the systemic ventricle and the pulmonary trunk is used as the neo-aorta. The native aorta is connected to the neo-aorta by creating the Damus-Kaye-Stansel (DKS) anastomosis. Despite the success of this staged approach, patients are limited in their performance throughout their lives and are at high risk of hemodynamic failure. We studied various conceivable anatomic aspects of the DKS anastomosis that may influence the coronary blood supply. Coronary blood flow depends solely on retrograde flow in the native aorta, when antegrade flow through the hypoplastic left ventricle and aortic valve is not present.

Method: We retrospectively analyzed 31 HLHS patients with a median age of 9.7 years (range: 0.25–17.1 years) who had cardiovascular magnetic resonance. We evaluated the impact of the following parameters on coronary blood flow: age, heart rate, cross-sectional area of the smallest part of the neo-aorta and the native aorta, length of the neo-aorta from the valve to the DKS anastomosis, the obtuse angle between the native aorta and the neo-aorta as well as the flow in the neo-aorta. None of the patients had antegrade flow in the native aorta so that blood flow in the native aorta represents the full coronary blood flow.

Results: Blood flow in the native aorta was very small compared to the flow in the neo-aorta. Median blood flow in the native aorta was 2.7% (range: 0.6–10.1%) of the flow in the neo-aorta (cardiac output). There is a marked positive correlation between heart rate and blood flow in the native aorta (R 2 = 0.252). The angles of the DKS confluence had no impact on blood flow in the native aorta. The median angle of the DKS anastomosis was 141 degrees (range: 114–177 degrees). Furthermore, we found no correlation between the cross-sectional area of the native aorta at the level of the DKS anastomosis and the blood flow in the native aorta. The cross-sectional area of the neo-aorta at the level of the DKS anastomosis correlated with the blood flow in the native aorta (median: 4.95 mm2, range: 1.36–11.52 mm2, R 2 = 0.2797).

Conclusion: Blood flow in the native aorta was very small. Heart rate and the cross-sectional area of the neo-aorta positively affect coronary blood supply in patients with hypoplastic left heart syndrome and may improve myocardial performance.



Publication History

Article published online:
28 January 2023

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