Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-26T08:29:53.171Z Has data issue: false hasContentIssue false
  • English
  • Français

Role of echocardiographic scoring systems in predicting successful biventricular versus univentricular palliation in neonates with critical aortic stenosis

Published online by Cambridge University Press:  03 September 2020

Shagun Sachdeva Open the ORCID record for Shagun Sachdeva [Opens in a new window] ,
Evelyn Kuhn ,
Peter C. Frommelt  and
Stephanie Handler
Shagun Sachdeva*
Affiliation:
Baylor College of Medicine, Houston, TX, USA
Evelyn Kuhn
Affiliation:
Medical College of Wisconsin, Milwaukee, WI, USA
Peter C. Frommelt
Affiliation:
Medical College of Wisconsin, Milwaukee, WI, USA
Stephanie Handler
Affiliation:
Medical College of Wisconsin, Milwaukee, WI, USA
*
Author for correspondence: Shagun Sachdeva, MD, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main St, Houston, TX77030, USA. Tel: +1 832 826 5600. E-mail: shagun.sachdeva@bcm.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

There are several published echo-derived scores to help predict successful biventricular versus univentricular palliation in neonates with critical aortic stenosis. This study aims to determine whether any published scoring system accurately predicted outcomes in these neonates.

Methods:

Single centre, retrospective cohort study including neonates who underwent aortic valve intervention (surgical valvotomy or balloon valvuloplasty) with the intention of biventricular circulation. Primary outcome was survival with biventricular circulation at hospital discharge. Data from their initial neonatal echocardiogram were used to compute the following scores – Rhodes, CHSS 1, Discriminant, CHSS 2, and 2 V.

Results:

Between 01/1999 and 12/2017, 68 neonates underwent aortic valve intervention at a median age of 4 days (range 1–29 days); 35 surgical valvotomy and 33 balloon valvuloplasty. Survival with biventricular circulation was maintained in 60/68 patients at hospital discharge. Of the remaining eight patients, three were converted to univentricular palliation, four died, and one underwent heart transplant prior to discharge. None of the binary score predictions of biventricular versus univentricular (using that score’s proposed cut-offs) were significantly associated with the observed outcome in this cohort. A high percentage of those predicted to need univentricular palliation had successful biventricular repair: 89.4% by Rhodes, 79.3% by CHSS 1, 85.2% by Discriminant, and 66.7% by CHSS 2 score. The 2 V best predicted outcome and agreed with the local approach in most cases.

Conclusion:

This study highlights the limitations of and need for alternative scoring systems/cut-offs for consistently accurate echocardiographic prediction of early outcome in neonates with critical aortic stenosis.

Keywords

Critical aortic stenosisechocardiographyaortic valvotomyaortic valvuloplasty
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 11 , November 2020 , pp. 1702 - 1707
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hickey, EJ, Caldarone, CA, McCrindle, BW. Left ventricular hypoplasia: a spectrum of disease involving the left ventricular outflow tract, aortic valve, and aorta. J Am Coll Cardiol. 2012; 59: S43–S54.CrossRefGoogle ScholarPubMed
Rhodes, LA, Colan, SD, Perry, SB, Jonas, RA, Sanders, SP. Predictors of survival in neonates with critical aortic stenosis. Circulation 1991; 84: 2325–2335.CrossRefGoogle ScholarPubMed
Lofland, GK, McCrindle, BW, Williams, WG, et al. Critical aortic stenosis in the neonate: a multi-institutional study of management, outcomes, and risk factors. Congenital Heart Surgeons Society. J Thorac Cardiovasc Surg 2001; 121: 10–27.CrossRefGoogle ScholarPubMed
Colan, SD, McElhinney, DB, Crawford, EC, Keane, JF, Lock, JE. Validation and re-evaluation of a discriminant model predicting anatomic suitability for biventricular repair in neonates with aortic stenosis. J Am Coll Cardiol 2006; 47: 1858–1865 CrossRefGoogle ScholarPubMed
Hickey, EJ, Caldarone, CA, Blackstone, EH, et al. Critical left ventricular outflow tract obstruction: the disproportionate impact of biventricular repair in borderline cases. J Thorac Cardiovasc Surg 2007; 134: 1429–1436; discussion 1436–1437.CrossRefGoogle ScholarPubMed
Cohen, MS. Assessing the borderline ventricle in a term infant: combining imaging and physiology to establish the right course. Curr Opin Cardiol 2018; 33: 95–100.CrossRefGoogle Scholar
Ma, X, Huang, G. Prediction of biventricular repair by echocardiography in borderline ventricle. Chinese Med J 2019; 132: 2105–2108.CrossRefGoogle ScholarPubMed
Mery, CM, Nieto, RM, De Leon, LE, et al. The role of echocardiography and intracardiac exploration in the evolution of candidacy for biventricular repair in patients with borderline left heart structures. Ann Thorac Surg 2017; 103: 853–861.CrossRefGoogle Scholar
Schwartz, ML, Gauvreau, K, Geva, T. Predictors of outcome of biventricular repair in infants with multiple left heart obstructive lesions. Circulation 2001; 104: 682–687.CrossRefGoogle ScholarPubMed
Mart, CR, Eckhauser, AW. Development of an echocardiographic scoring system to predict biventricular repair in neonatal hypoplastic left heart complex. Pediatr Cardiol 2014; 35: 1456–1466.CrossRefGoogle ScholarPubMed
Cavigelli-Brunner, A, Bauersfeld, U, Pretre, R, et al. Outcome of biventricular repair in infants with multiple left heart obstructive lesions. Pediatr Cardiol 2012; 33: 506–512.CrossRefGoogle ScholarPubMed
Grosse-Wortmann, L, Yun, TJ, Al-Radi, O, et al. Borderline hypoplasia of the left ventricle in neonates: insights for decision-making from functional assessment with magnetic resonance imaging. J Thorac Cardiovasc Surg 2008; 136: 1429–1436.CrossRefGoogle ScholarPubMed
Banka, P, Schaetzle, B, Komarlu, R, Emani, S, Geva, T, Powell, A. Cardiovascular magnetic resonance parameters associated with early transplant free survival in children with small left hearts following conversion from a univentricular to biventricular circulation. J Cardiovasc Mag Res 2014; 16: 73.CrossRefGoogle ScholarPubMed