{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:50:23Z","timestamp":1787503823402,"version":"build-2736575974"},"reference-count":28,"publisher":"BMJ","issue":"3","funder":[{"name":"Willy Robert Pitzer Stiftung, Bad Nauheim, Germany."},{"name":"Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre, London, UK"},{"name":"Doris-Haag Stiftung, Frankfurt am Main, Germany"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2017,6,22]]},"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Norwood and hybrid procedure are two options available for initial palliation of patients with hypoplastic left heart syndrome (HLHS). Our study aimed to assess potential differences in right ventricular (RV) function and pulmonary artery dimensions using cardiac magnetic resonance (CMR) in survivors with HLHS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>42 Norwood (mean age 2.4\u00b10.8) and 44 hybrid (mean age 2.0\u00b11.0 years) patients were evaluated by CMR after stage II palliation prior to planned Fontan completion. Initial stage I Norwood procedure was performed using a modified Blalock-Taussig shunt, while the hybrid procedure consisted of bilateral pulmonary artery banding and arterial duct stenting. Need for reinterventions and subsequent outcomes were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Norwood patients had larger RV end-diastolic dimensions (91\u00b123 vs 80\u00b131 mL\/m\n                      <jats:sup>2<\/jats:sup>\n                      , p=0.004) and lower heart rate (90\u00b115 vs 102\u00b113, p&lt;0.001) than hybrid patients. Both Norwood and hybrid patients showed preserved global RV pump function (59\u00b19 vs 59%\u00b110%, p=0.91), while RV strain, strain rate and intraventricular synchrony were superior in the Norwood group. Pulmonary artery size was reduced (lower lobe index 135\u00b174 vs 161\u00b162 mm\n                      <jats:sup>2<\/jats:sup>\n                      \/m\n                      <jats:sup>2<\/jats:sup>\n                      , p=0.02), and reintervention rate was significantly higher in the hybrid group whereas subsequent outcome did not differ significantly (p=0.24).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Norwood and hybrid strategy were associated with equivalent and preserved global RV pump function while development of the pulmonary arteries and reintervention rate were superior using the Norwood approach. Impaired RV myocardial deformation as a potential marker of early RV dysfunction in the hybrid group may have a negative long-term impact in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/heartjnl-2017-311532","type":"journal-article","created":{"date-parts":[[2017,7,28]],"date-time":"2017-07-28T20:40:42Z","timestamp":1501274442000},"page":"244-252","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome"],"prefix":"10.1136","volume":"104","author":[{"given":"Heiner","family":"Latus","sequence":"first","affiliation":[{"name":"Pediatric Heart Centre, University Children\u2019s Hospital, Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed S","family":"Nassar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Cardiac Surgery, Evelina London Children\u2019s Hospital, Guy\u2019s and St. Thomas' NHS Foundation Trust, London, UK"},{"name":"Division of Imaging Sciences and Biomedical Engineering, King\u2019s College London, London, UK"},{"name":"Department of Cardiothoracic Surgery, Alexandria University, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology and Cardiac Surgery, Evelina London Children\u2019s Hospital, Guy\u2019s and St. Thomas' NHS Foundation Trust, London, UK"},{"name":"Division of Imaging Sciences and Biomedical Engineering, King\u2019s College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Hachmann","sequence":"additional","affiliation":[{"name":"Pediatric Heart Centre, University Children\u2019s Hospital, Giessen, 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