TY - JOUR
T1 - Conal septal morphometrics can identify higher risk neonates with tetralogy of fallot
AU - Uppu, Santosh C.
AU - Dyamenahalli, Umesh
AU - Sachdeva, Ritu
AU - Imamura, Michiaki
AU - Morrow, W. Robert
AU - Gossett, Jeffrey M.
AU - Swearingen, Christopher J.
AU - Vyas, Himesh V.
PY - 2013/2
Y1 - 2013/2
N2 - Background: Some neonates with tetralogy of Fallot (TOF) have rapid progression of right ventricular outflow tract obstruction, requiring early repair irrespective of Doppler gradient as measured in the neonatal period. The aim of this study was to test the hypothesis that infundibular morphology in neonates with TOF is associated with the occurrence of hypercyanotic spells and need for neonatal surgery. Methods: Fifty patients with TOF undergoing surgical repair from 2003 to 2009 were studied. Neonatal echocardiograms were retrospectively analyzed to measure conal septal angle (the angle between the conal septum and the horizontal plane passing through the center of the aortic valve in the parasternal short-axis view, with a larger angle denoting more anterocephalad deviation of conal septum), conal septal thickness and length, the degree of aortic dextroposition, and sizes and Z scores of the pulmonary annulus and the main and branch pulmonary arteries. Outcomes included the occurrence of hypercyanotic spells and the need for neonatal surgery. Results: The median age at first echocardiogram was 2 days (range, 0-12 days). The median age at surgery was 94 days (range, 5-282 days); hypercyanotic spells occurred in 17 patients (34%), and nine (18%) underwent neonatal repair. The presence of a wider conal septal angle was significantly associated with the occurrence of hypercyanotic spells (59 ± 21° vs 48 ± 13°, P =.023) and the need for neonatal surgery (67 ± 13° vs 48 ± 16°, P =.004). The positive and negative predictive values of hypercyanotic spells for conal septal angles ≥60° were 64% and 78%, respectively. Importantly, Doppler right ventricular outflow tract gradient at initial echocardiography, degree of aortic dextroposition, and pulmonary or aortic valve size were not associated with these outcomes. Conclusions: A wider conal septal angle is associated with the occurrence of hypercyanotic spells and the need for neonatal surgery.
AB - Background: Some neonates with tetralogy of Fallot (TOF) have rapid progression of right ventricular outflow tract obstruction, requiring early repair irrespective of Doppler gradient as measured in the neonatal period. The aim of this study was to test the hypothesis that infundibular morphology in neonates with TOF is associated with the occurrence of hypercyanotic spells and need for neonatal surgery. Methods: Fifty patients with TOF undergoing surgical repair from 2003 to 2009 were studied. Neonatal echocardiograms were retrospectively analyzed to measure conal septal angle (the angle between the conal septum and the horizontal plane passing through the center of the aortic valve in the parasternal short-axis view, with a larger angle denoting more anterocephalad deviation of conal septum), conal septal thickness and length, the degree of aortic dextroposition, and sizes and Z scores of the pulmonary annulus and the main and branch pulmonary arteries. Outcomes included the occurrence of hypercyanotic spells and the need for neonatal surgery. Results: The median age at first echocardiogram was 2 days (range, 0-12 days). The median age at surgery was 94 days (range, 5-282 days); hypercyanotic spells occurred in 17 patients (34%), and nine (18%) underwent neonatal repair. The presence of a wider conal septal angle was significantly associated with the occurrence of hypercyanotic spells (59 ± 21° vs 48 ± 13°, P =.023) and the need for neonatal surgery (67 ± 13° vs 48 ± 16°, P =.004). The positive and negative predictive values of hypercyanotic spells for conal septal angles ≥60° were 64% and 78%, respectively. Importantly, Doppler right ventricular outflow tract gradient at initial echocardiography, degree of aortic dextroposition, and pulmonary or aortic valve size were not associated with these outcomes. Conclusions: A wider conal septal angle is associated with the occurrence of hypercyanotic spells and the need for neonatal surgery.
KW - Echocardiography
KW - Hypercyanotic spells
KW - Neonatal cardiac surgery
KW - Tetralogy of Fallot
UR - https://www.scopus.com/pages/publications/84872934482
U2 - 10.1016/j.echo.2012.10.020
DO - 10.1016/j.echo.2012.10.020
M3 - Article
C2 - 23218966
AN - SCOPUS:84872934482
SN - 0894-7317
VL - 26
SP - 200
EP - 207
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 2
ER -