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Impact of Anatomical Sub-types and Shunt Types on Aortopulmonary Collaterals in Hypoplastic Left Heart Syndrome

  • Author Footnotes
    # Both authors contributed equally.
    Melvin Schmiel
    Footnotes
    # Both authors contributed equally.
    Affiliations
    Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Bavaria, Germany
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  • Author Footnotes
    # Both authors contributed equally.
    Masamichi Ono
    Correspondence
    Address reprint requests to Masamichi Ono, Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Lazarettstraße 36, 80636 Munich, Bavaria, Germany.
    Footnotes
    # Both authors contributed equally.
    Affiliations
    Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Bavaria, Germany
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  • Helena Staehler
    Affiliations
    Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Bavaria, Germany
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  • Stanimir Georgiev
    Affiliations
    Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich at the Technical University of Munich, Munich, Bavaria, Germany
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  • Melchior Burri
    Affiliations
    Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Bavaria, Germany
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  • Paul Philipp Heinisch
    Affiliations
    Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Bavaria, Germany
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  • Martina Strbad
    Affiliations
    Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Bavaria, Germany
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  • Peter Ewert
    Affiliations
    Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich at the Technical University of Munich, Munich, Bavaria, Germany
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  • Alfred Hager
    Affiliations
    Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich at the Technical University of Munich, Munich, Bavaria, Germany
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  • Jürgen Hörer
    Affiliations
    Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich Germany, Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Bavaria, Germany
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  • Author Footnotes
    # Both authors contributed equally.
      This study aims to clarify the relation of development of aortopulmonary collateral arteries (APCs) with anatomical sub-types and the shunt types at Norwood procedure in patients with hypoplastic left heart syndrome (HLHS). A total of 140 patients with HLHS who completed 3 staged palliation between 2003 and 2019 were included. Incidence of APCs and corresponding interventions were examined using angiogram by cardiac catheterization, with respect to the anatomical sub-types and shunt types. Totally, APCs were observed in 87 (62%) of the patients; pre-stage II in 32 (23%), pre-stage III in 64 (46%), and after stage III in 40 (29%). The incidence of APCs before stage II was significantly higher in patients with aortic atresia/mitral atresia (AA/MA) compared with other sub-types (P = 0.022). Patients with right ventricle to pulmonary artery conduit (RVPAC) had a higher incidence of APCs originating from the descending aorta, compared with those with modified Blalock-Taussig shunt (20% vs 2%, P= 0.002). Interventions for APCs were performed in 58 (41%) patients; before stage II in 10 (7%), after stage II in 7 (5%), before stage III in 22 (16%), and after stage III in 32 (23%). Patients with AA/MA had more interventions before stage II (P= 0.019), and patients with aortic stenosis/mitral stenosis (AS/MS) had a lower incidence of interventions after stage III (P= 0.047). More than half of the patients with HLHS developed APCs. Before stage II, patients with AA/MA sub-type had a higher incidence of APCs, and those with RVPAC had significantly more APCs from the descending aorta.

      Graphical abstract

      Keywords

      Abbreviations:

      AA (aortic atresia), APCs (aortopulmonary collaterals), AS (aortic stenosis), BCPS (bidirectional cavopulmonary shunt), CMR (cardiac magnetic resonance), CPB (cardiopulmonary bypass), HLHS (hypoplastic left heart syndrome), ICU (intensive care unit), IQR (interquartile ranges), LIMA (left internal mammary artery), MA (mitral atresia), MBTS (modified Blalock-Taussig shunt), MS (mitral stenosis), PA (pulmonary artery), PAP (pulmonary artery pressure), RIMA (right internal mammary artery), RVPAC (right ventricle to pulmonary artery conduit), SO2 (aortic oxygen saturation), TCPC (total cavopulmonary connection)
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      Linked Article

      • Commentary: Aortopulmonary Collaterals in Hypoplastic Left heart Syndrome: Chicken or the Egg?
        Seminars in Thoracic and Cardiovascular Surgery
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          In this issue, Schmiel et al. present a retrospective, single-center study evaluating the relationship of hypoplastic left heart syndrome (HLHS) subtype and shunt type at the Norwood procedure on the development of aortopulmonary collaterals (APCs).1 Aortopulmonary collaterals were determined by angiography, which was undertaken in all patients prior to stage 2 (bidirectional Glenn procedure) and prior to stage 3 (extra-cardiac Fontan procedure).
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