Ultrasound assessment of mesenteric blood flow in neonates with hypoplastic left heart before and after hybrid palliation

Abstract Background: Altered mesenteric perfusion may be a contributor to the development of necrotising enterocolitis in patients with hypoplastic left heart syndrome. The goal of this study was to document mesenteric flow patterns in patients with hypoplastic left heart syndrome pre- and post-hybrid procedure. Methods: A prospective study on all patients with hypoplatic left heart syndrome undergoing the hybrid procedure was conducted. Doppler ultrasound analysis of the coeliac and superior mesenteric artery was performed. Results: A total of 13 patients were evaluated. There was a significant difference in the coeliac artery effective velocity-time intergral pre- and post-hybrid procedure (8.69±3.84 versus 12.51±4.95 cm, respectively). There were significant differences in the superior mesenteric artery antegrade velocity-time integral pre- and post-hybrid procedure (6.86±2.45 versus 10.52±2.64 cm, respectively) and superior mesenteric artery effective velocity-time integral pre- and post-hybrid procedure (6.22±2.68 versus 9.73±2.73 cm, respectively). There were no significant differences between the coeliac and superior mesenteric artery Doppler indices in the pre-hybrid procedure; there were, however, significant differences in the post-hybrid procedure between coeliac and superior mesenteric artery antegrade velocity-time integral (13.8 2±5.60 versus 10.52±2.64 cm, respectively) and effective velocity-time integral (13.04±4.71 versus 9.73±2.73 cm, respectively). Conclusion: Doppler mesenteric indices of perfusion improve in patients with hypoplastic left heart syndrome after the hybrid procedure; however, there appears to be preferential flow to the coeliac artery versus the superior mesenteric artery in these patients post-procedure.

[1]  E. Armbrecht,et al.  Feeding preterm neonates with patent ductus arteriosus (PDA): intestinal blood flow characteristics and clinical outcomes , 2015, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[2]  T. Miller,et al.  Abnormal Abdominal Aorta Hemodynamics Are Associated With Necrotizing Enterocolitis in Infants With Hypoplastic Left Heart Syndrome , 2014, Pediatric Cardiology.

[3]  J. Cheatham,et al.  Diastolic flow parameters are not sensitive in predicting necrotizing enterocolitis in patients undergoing hybrid procedure. , 2013, Congenital heart disease.

[4]  K. Mukhopadhyay,et al.  Superior mesenteric artery Doppler is poor at predicting feed intolerance and NEC in preterm small for gestational age neonates , 2013, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[5]  C. Cua,et al.  Intestinal location of necrotizing enterocolitis among infants with congenital heart disease , 2013, Journal of Perinatology.

[6]  Jennifer S. Li,et al.  Celiac Artery Flow Pattern in Infants with Single Right Ventricle Following the Norwood Procedure with a Modified Blalock-Taussig or Right Ventricle to Pulmonary Artery Shunt , 2011, Pediatric Cardiology.

[7]  J. Cheatham,et al.  Necrotizing enterocolitis in neonates undergoing the hybrid approach to complex congenital heart disease* , 2011, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[8]  J. Cheatham,et al.  Echocardiographic parameters that predict outcome in aortic atresia patients undergoing comprehensive stage II procedure. , 2010, Congenital heart disease.

[9]  R. Thiagarajan,et al.  Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation , 2009, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[10]  C. Romagnoli,et al.  Neonatal colour Doppler ultrasound study: normal values of abdominal blood flow velocities in the neonate during the first month of life , 2009, Pediatric Radiology.

[11]  M. Campbell,et al.  Cerebral and splanchnic hemodynamics after duct ligation in very low birth weight infants. , 2009, The Journal of pediatrics.

[12]  J. Cheatham,et al.  Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve. , 2008, The Annals of thoracic surgery.

[13]  P. Ilves,et al.  Developmental Changes in Cerebral and Visceral Blood Flow Velocity in Healthy Neonates and Infants , 2008, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[14]  David C. Sheridan,et al.  Effect of shunt type on echocardiographic indices after initial palliations for hypoplastic left heart syndrome: Blalock-Taussig shunt versus right ventricle-pulmonary artery conduit. , 2007, Journal of the American Society of Echocardiography.

[15]  J. Cheatham,et al.  Palliation via hybrid procedure of a 1.4-kg patient with a hypoplastic left heart. , 2007, Congenital heart disease.

[16]  W. Border,et al.  Persistent Diastolic Flow Reversal in Abdominal Aortic Doppler-Flow Profiles Is Associated With an Increased Risk of Necrotizing Enterocolitis in Term Infants With Congenital Heart Disease , 2007, Pediatrics.

[17]  H. Jeffries,et al.  Mesenteric blood flow velocities in the newborn with single-ventricle physiology: Modified Blalock-Taussig shunt versus right ventricle-pulmonary artery conduit , 2006, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[18]  H. Jeffries,et al.  Gastrointestinal morbidity after Norwood palliation for hypoplastic left heart syndrome. , 2006, The Annals of thoracic surgery.

[19]  J. Connor,et al.  Neonates with hypoplastic left heart syndrome have ultrasound evidence of abnormal superior mesenteric artery perfusion before and after modified Norwood procedure , 2005, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[20]  S. Chida,et al.  Cardiocirculatory effects of patent ductus arteriosus in extremely low‐birth‐weight infants with respiratory distress syndrome , 2003, Pediatrics international : official journal of the Japan Pediatric Society.

[21]  P. Bonhoeffer,et al.  Unusual interventional management in an adult with tetralogy of Fallot , 2003, Cardiology in the Young.

[22]  Y. Cheung,et al.  Mesenteric blood flow response to feeding after systemic-to-pulmonary arterial shunt palliation. , 2003, The Annals of thoracic surgery.

[23]  T. Spray,et al.  Necrotizing Enterocolitis in Neonates With Congenital Heart Disease: Risk Factors and Outcomes , 2000, Pediatrics.

[24]  S. Hiraishi,et al.  Regional Blood Flow Distribution and Left Ventricular Output during Early Neonatal Life: A Quantitative Ultrasonographic Assessment , 1994, Pediatric Research.

[25]  W. Norwood,et al.  Mesenteric ischemia in hypoplastic left heart syndrome. , 1992, Journal of pediatric surgery.

[26]  D. Flynn,et al.  NECROTISING ENTEROCOLITIS , 1977, The Lancet.

[27]  J. Stockman,et al.  Comparison of Shunt Types in the Norwood Procedure for Single-Ventricle Lesions , 2012 .