The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2017
Comparative StudyComparison of right ventricle-pulmonary artery shunt position in the Single Ventricle Reconstruction trial.
Placement of a right ventricle-pulmonary artery shunt to the left or right of the neoaorta may influence reinterventions, pulmonary artery development, and survival after the Norwood procedure because of differences in shunt and pulmonary artery geometry and blood flow. ⋯ In the Single Ventricle Reconstruction trial, right ventricle-pulmonary artery shunt placement to the right of the neoaorta was associated with fewer shunt revisions and may contribute to improved outcomes in select patients.
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J. Thorac. Cardiovasc. Surg. · Jun 2017
Geometry and growth of the reconstructed aorta in patients with hypoplastic left heart syndrome and variants.
The interdigitating technique in aortic arch reconstruction in hypoplastic left heart syndrome and variants (HLHS) reduces the recoarctation rate. Little is known on aortic arch growth characteristics and resulting clinical impact. ⋯ The aortic arch after reconstruction with the interdigitating technique differs from normal. Growth was proportional with no further geometrical distortion. Recoarctation and reintervention rate is low. Further improvement may be achieved by optimizing patch configuration and material.
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J. Thorac. Cardiovasc. Surg. · Jun 2017
Characterizing saccular aortic arch aneurysms from the geometry-flow dynamics relationship.
Low wall shear stress (WSS) has been reported to be associated with accelerated atherosclerosis, aneurysm growth, or rupture. We evaluated the geometry of aortic arch aneurysms and their relationship with WSS by using the 4-dimensional flow magnetic resonance imaging to better characterize the saccular aneurysms. ⋯ Fusiform aneurysms elongate as they dilate, and WSS is lower as the diameter is larger. Saccular aneurysms dilate without proportionate elongation, and they, especially those occupying the inner curvature, have higher and variable sac depth/neck width ratio. When this ratio exceeds 0.8, WSS is low regardless of diameter, which may explain their malignant clinical behavior.