{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:02:22Z","timestamp":1753876942529,"version":"3.41.2"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T00:00:00Z","timestamp":1715817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Our goal was to evaluate the impact of variable morphology of the native ascending aorta after the Norwood I procedure in patients with hypoplastic left heart syndrome\/aortic atresia on long-term survival and systemic right ventricular dysfunction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Of 151 survivors of the Norwood procedure for hypoplastic left heart syndrome\/aortic atresia at our institution between January 2001 and December 2020, we included patients with available and measurable aortograms prior to stage II palliation. The diameter of the native ascending aorta, the length of the native ascending aorta and the angle between the native ascending aorta and the proximal pulmonary artery were measured. We investigated the impact of these morphologic parameters on mortality and on right ventricular dysfunction (defined as at least moderate).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Angiograms were available for 78 patients. The median diameter of the native ascending aorta was 3.2\u2009mm (2.6\u20133.7), the median length of the native ascending aorta was 15.4\u2009mm (13.3\u201317.9) and the median angle between the native ascending aorta and the proximal pulmonary artery was 44\u00b0 (35\u00b0\u201351\u00b0). During the median follow-up of 6.5\u2009years, 8 (10%) patients died and systemic right ventricular dysfunction occurred in 19 patients (24%). No significant association between aortic morphology and mortality could be detected. Right ventricular function was negatively affected by a larger angle between the native ascending aorta and the proximal pulmonary artery [odds ratio 1.07 (1.01\u20131.14), P\u2009=\u20090.02].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>In survivors of the Norwood procedure for hypoplastic left heart syndrome\/aortic atresia with available angiograms, no significant association between native aortic morphology and mortality could be demonstrated after stage II palliation, within the scope of this limited study. A larger anastomosis angle between the native ascending aorta and the proximal pulmonary artery emerged as a risk factor for right ventricular dysfunction.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/icvts\/ivae101","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T20:54:56Z","timestamp":1715892896000},"source":"Crossref","is-referenced-by-count":0,"title":["Morphology of the native ascending aorta after the Norwood procedure for aortic atresia: impact on survival and right ventricular dysfunction"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6842-2988","authenticated-orcid":false,"given":"Thibault","family":"Schaeffer","sequence":"first","affiliation":[{"name":"Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen , Munich, Germany"},{"name":"Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universit\u00e4t , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2606-0557","authenticated-orcid":false,"given":"Paul Philipp","family":"Heinisch","sequence":"additional","affiliation":[{"name":"Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen , Munich, Germany"},{"name":"Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universit\u00e4t , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4034-3967","authenticated-orcid":false,"given":"Helena","family":"Staehler","sequence":"additional","affiliation":[{"name":"Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6239-8160","authenticated-orcid":false,"given":"Stanimir","family":"Georgiev","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"R\u00f6hlig","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2481-2017","authenticated-orcid":false,"given":"Alfred","family":"Hager","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0253-1190","authenticated-orcid":false,"given":"Peter","family":"Ewert","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"H\u00f6rer","sequence":"additional","affiliation":[{"name":"Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen , Munich, Germany"},{"name":"Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universit\u00e4t , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5699-6394","authenticated-orcid":false,"given":"Masamichi","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universit\u00e4t M\u00fcnchen , Munich, Germany"},{"name":"Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universit\u00e4t , Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,5,16]]},"reference":[{"key":"2024072522451003900_ivae101-B1","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1161\/CIRCULATIONAHA.116.022816","article-title":"Current therapy for hypoplastic left heart syndrome and related single ventricle lesions","volume":"134","author":"Ohye","year":"2016","journal-title":"Circulation"},{"key":"2024072522451003900_ivae101-B2","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1161\/hc1002.105182","article-title":"Heart failure and ventricular dysfunction in patients with single or systemic right ventricles","volume":"105","author":"Piran","year":"2002","journal-title":"Circulation"},{"key":"2024072522451003900_ivae101-B3","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.healun.2018.02.009","article-title":"Heart failure after the Norwood procedure: an analysis of the Single Ventricle Reconstruction Trial","volume":"37","author":"Mahle","year":"2018","journal-title":"J Heart Lung Transplant"},{"key":"2024072522451003900_ivae101-B4","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1007\/s00246-018-1923-7","article-title":"Systemic ventricular dysfunction between stage one and stage two palliation","volume":"39","author":"Kulik","year":"2018","journal-title":"Pediatr Cardiol"},{"key":"2024072522451003900_ivae101-B5","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1016\/S0003-4975(97)01041-2","article-title":"Causes of death after the modified Norwood procedure: a study of 122 postmortem cases","volume":"64","author":"Bartram","year":"1997","journal-title":"Ann Thorac Surg"},{"key":"2024072522451003900_ivae101-B6","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.jtcvs.2012.01.016","article-title":"Intermediate-term mortality and cardiac transplantation in infants with single-ventricle lesions: risk factors and their interaction with shunt type","volume":"144","author":"Tweddell","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024072522451003900_ivae101-B7","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.athoracsur.2015.03.106","article-title":"Impact of patient characteristics and anatomy on results of Norwood operation for hypoplastic left heart syndrome","volume":"100","author":"Alsoufi","year":"2015","journal-title":"Ann Thorac Surg"},{"key":"2024072522451003900_ivae101-B8","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1016\/j.athoracsur.2020.02.037","article-title":"Does ascending aorta size affect Norwood outcomes in hypoplastic left heart with aortic atresia?","volume":"110","author":"Carvajal","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2024072522451003900_ivae101-B9","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1093\/icvts\/ivab073","article-title":"Preoperative risk factors influencing inter-stage mortality after the Norwood procedure","volume":"33","author":"Ono","year":"2021","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2024072522451003900_ivae101-B10","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1016\/j.athoracsur.2015.10.077","article-title":"Vulnerability of coronary circulation after Norwood operation","volume":"101","author":"Saiki","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"2024072522451003900_ivae101-B11","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1016\/j.athoracsur.2012.11.015","article-title":"Recoarctation after the Norwood I procedure for hypoplastic left heart syndrome: incidence, risk factors, and treatment options","volume":"95","author":"Cleuziou","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2024072522451003900_ivae101-B12","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.ejcts.2008.04.043","article-title":"Bidirectional cavopulmonary connection without additional pulmonary blood flow as an ideal staging for functional univentricular hearts","volume":"34","author":"Schreiber","year":"2008","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024072522451003900_ivae101-B13","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.athoracsur.2007.04.034","article-title":"Nonfenestrated extracardiac total cavopulmonary connection in 132 consecutive patients","volume":"84","author":"Schreiber","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"2024072522451003900_ivae101-B14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"2024072522451003900_ivae101-B15","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1053\/j.semtcvs.2021.11.012","article-title":"Influence of shunt type on survival and right heart function after the Norwood procedure for aortic atresia","volume":"34","author":"Piber","year":"2022","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2024072522451003900_ivae101-B16","doi-asserted-by":"crossref","first-page":"2026","DOI":"10.1016\/j.jacc.2014.08.033","article-title":"Impact of initial shunt type on cardiac size and function in children with single right ventricle anomalies before the Fontan procedure: the single ventricle reconstruction extension trial","volume":"64","author":"Frommelt","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2024072522451003900_ivae101-B17","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/ejcts\/ezx102","article-title":"Initial shunt type at the Norwood operation impacts myocardial function in hypoplastic left heart syndrome","volume":"52","author":"Ruotsalainen","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024072522451003900_ivae101-B18","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1161\/CIRCULATIONAHA.123.065192","article-title":"Longitudinal follow-up of children with HLHS and association between Norwood shunt type and long-term outcomes: the SVR III Study","volume":"148","author":"Goldberg","year":"2023","journal-title":"Circulation"},{"key":"2024072522451003900_ivae101-B19","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/S1010-7940(00)00495-4","article-title":"Factors influencing early outcome of Norwood procedure for hypoplastic left heart syndrome","volume":"18","author":"Malec","year":"2000","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024072522451003900_ivae101-B20","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1067\/mtc.2003.183","article-title":"Outcomes after the Norwood operation in neonates with critical aortic stenosis or aortic valve atresia","volume":"125","author":"Ashburn","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024072522451003900_ivae101-B21","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.jtcvs.2012.05.020","article-title":"Interstage mortality after the Norwood procedure: results of the multicenter Single Ventricle Reconstruction trial","volume":"144","author":"Ghanayem","year":"2012","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024072522451003900_ivae101-B22","first-page":"I70","article-title":"Analysis of potential anatomic or physiologic determinants of outcome of palliative surgery for hypoplastic left heart syndrome","volume":"74","author":"Helton","year":"1986","journal-title":"Circulation"},{"key":"2024072522451003900_ivae101-B23","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S1010-7940(99)00155-4","article-title":"Results after Norwood procedure and subsequent cavopulmonary anastomoses for typical hypoplastic left heart syndrome and similar complex cardiovascular malformations","volume":"16","author":"Breymann","year":"1999","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024072522451003900_ivae101-B24","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1093\/ejcts\/ezab312","article-title":"Patch augmentation of small ascending aorta during stage I procedure reduces the risk of morbidity and mortality","volume":"61","author":"Hoganson","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024072522451003900_ivae101-B25","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/S0022-5223(98)70448-9","article-title":"Resting coronary flow and coronary flow reserve in human infants after repair or palliation of congenital heart defects as measured by positron emission tomography","volume":"115","author":"Donnelly","year":"1998","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivae101\/57708130\/ivae101.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/39\/1\/ivae101\/58653490\/ivae101.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/39\/1\/ivae101\/58653490\/ivae101.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T23:24:43Z","timestamp":1721949883000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivae101\/7675477"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,16]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivae101","relation":{},"ISSN":["2753-670X"],"issn-type":[{"type":"electronic","value":"2753-670X"}],"subject":[],"published-other":{"date-parts":[[2024,7]]},"published":{"date-parts":[[2024,5,16]]},"article-number":"ivae101"}}