Usefulness of preoperative echocardiography in predicting left ventricular outflow obstruction after primary repair of interrupted aortic arch with ventricular septal defect

Residual left ventricular outflow tract (LVOT) obstruction is a significant problem after repair of interrupted aortic arch (IAA) and ventricular septal defect. Resection of subaortic tissue at the time of primary repair, however, is associated with increased morbidity and mortality. We reviewed the...

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Bibliographic Details
Published in:	The American journal of cardiology Vol. 82; no. 4; pp. 470 - 473
Main Authors:	Apfel, Howard D., Levenbraun, Joseph, Quaegebeur, Jan M., Allan, Lindsey D.
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 15-08-1998 Elsevier Elsevier Limited
Subjects:	Adolescent Aorta, Thoracic - surgery Aortic Arch Syndromes - complications Aortic Arch Syndromes - diagnostic imaging Aortic Arch Syndromes - surgery Biological and medical sciences Cardiology Cardiology. Vascular system Child Child, Preschool Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava Echocardiography, Doppler Female Heart Heart Septal Defects, Ventricular - complications Heart Septal Defects, Ventricular - diagnostic imaging Heart Septal Defects, Ventricular - surgery Humans Infant Infant, Newborn Male Medical procedures Medical sciences Predictive Value of Tests Preoperative Care Prognosis Retrospective Studies Surgery Ventricular Outflow Obstruction - diagnostic imaging Ventricular Outflow Obstruction - etiology Sonography Human Echocardiography Prognosis Ventricular septal defect Cardiovascular disease Intracardiac defect Aortic arch syndrome Congenital disease Left ventricle Outflow obstruction Vascular disease Treatment Malformation Follow up study Heart disease Surgery Primary Preoperative Aortic disease
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Summary:	Residual left ventricular outflow tract (LVOT) obstruction is a significant problem after repair of interrupted aortic arch (IAA) and ventricular septal defect. Resection of subaortic tissue at the time of primary repair, however, is associated with increased morbidity and mortality. We reviewed the preoperative echocardiograms and the postoperative clinical course and echocardiograms of 23 consecutive patients who underwent primary repair of IAA without widening of the subaortic region. Nine patients (39%) developed significant LVOT obstruction (pressure gradient >40 mm Hg). LVOT obstruction was noted postoperatively in 7 of 9 patients by 1 month, 8 of 9 by 2 months, and 9 of 9 by 1 year. On retrospective analysis of the preoperative echocardiograms, the indexed cross-sectional area of the LVOT, the subaortic diameter index, and the subaortic diameter Z score were all significantly smaller in those requiring reintervention (p <0.04, p <0.05, p <0.05, respectively). Of these, indexed cross-sectional area had the least reproducibility and subaortic diameter index the most (coefficient of variation of 26.3% vs 11.2%). In conclusion, most patients who develop significant LVOT obstruction after repair of IAA do so within 1 month of operation. Although subaortic indexed cross-sectional area is the most sensitive predictor of LVOT obstruction after primary repair of IAA, other more simple standardized measurements of the subaortic diameter were comparably predictive and had better reproducibility.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9149 1879-1913
DOI:	10.1016/S0002-9149(98)00362-2