• Giovanni Biglino, Alessandro Giardini, Hopewell N Ntsinjana, Silvia Schievano, Tain-Yen Hsia, Andrew M Taylor, and Modeling of Congenital Hearts Alliance Collaborative Group.
• Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, University College London, and Cardiorespiratory Division, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom. Electronic address: g.biglino@ucl.ac.uk.
• J. Thorac. Cardiovasc. Surg. 2014 Oct 1; 148 (4): 1526-33.

ObjectiveTo assess the coupling efficiency in hypoplastic left heart syndrome, considering the effect of surgical arch reconstruction and the shunt type received during the Norwood procedure.MethodsVentriculoarterial coupling was assessed before Fontan completion in 32 patients with hypoplastic left heart syndrome (19 modified Blalock-Taussig and 13 Sano shunts at stage 1). Cardiovascular magnetic resonance data were analyzed, deriving functional parameters and 3-dimensional volumes. Dimensional indexes were computed from 3-dimensional data sets as the area ratio of the isthmus to the descending aorta (Risthmus) and the isthmus to surgically enlarged transverse arch (Rarch). Wave intensity was calculated from cardiac magnetic resonance, using the peaks of the forward compression and expansion waves in early and late systole as surrogate indicators of ventriculoarterial coupling.ResultsAortic distensibility (3.6±2.7×10(-3) 1/mm Hg) was not associated with the time elapsed from stage 1 palliation (P=.94), suggesting an early loss of elasticity that did not progress thereafter. Risthmus was 1.0±0.4, and Rarch was 0.3±0.1, indicating the dilated reconstructed arch was the main anatomic feature. The forward compression wave correlated significantly with Rarch (R2=0.23, P=.006) but not with Risthmus (R2<0.01, P=.63). Patients with a reduced ejection fraction exhibited a larger ventricular mass (R2=0.28, P=.003). The Sano shunt patients had a lower ejection fraction (51%±6% vs 57%±6%, P=.02); however, neither the forward compression nor expansion wave varied significantly between shunt type or the other functional parameters.ConclusionsVentriculoarterial coupling in operated hypoplastic left heart syndrome was affected by aortic arch size mismatch but not by the type of shunt placed at the Norwood operation.Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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