Hypoplastic left heart syndrome (HLHS) is a congenital heart disease whose staged surgical palliation aims to progressively separate the systemic and pulmonary circulations. The first stage or Norwood procedure  involves surgical reconstruction of the aortic arch, usually with pulmonary homograft patch . Recent evidence suggested that, because of this extensive reconstruction, HLHS patients have abnormal elastic properties  and reduced distensibility [4,5] of the ascending aorta. However, the impact of the reconstructed aorta and its abnormal elastic properties on ventricular mechanics, i.e. ventriculo-arterial coupling mismatch, has not been assessed. In the light of this mismatch, a change in impedance on the arterial side will reflect on the ventricular side and quantification of this phenomenon may provide mechano-energetic information for further understanding a complex physiology such as palliated HLHS with aortic arch surgical reconstruction. In this study we suggest that wave intensity analysis (WIA) is a valid method for studying ventriculo-arterial coupling, as WIA is a hemodynamic index able to assess the performance of the heart and its interaction with arterial system. Previously, distensibility quantification necessitated either of invasive  or cuff  arterial pressure monitoring, or multiple magnetic resonance (MR) images acquisitions for transit time wave speed calculation . Instead, here we propose a non-invasive and semi-automated method based only on MR images analysis, with single slice analysis for estimate of local distensibility. The method, including WIA, was developed as a plug-in for DICOM viewer OsiriX, and applied to two cohorts of single ventricle patients.
- Bioengineering Division
A Non-Invasive Study Using MR-Derived Wave Intensity Analysis to Highlight the Effect of Surgical Arch Reconstruction on Ventriculo-Arterial Coupling in Patients With Hypoplastic Left Heart Syndrome
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Biglino, G, Ntsinjana, H, Steeden, JA, Baker, C, Schievano, S, Khambadkone, S, Hsia, T, Taylor, AM, & Giardini, A. "A Non-Invasive Study Using MR-Derived Wave Intensity Analysis to Highlight the Effect of Surgical Arch Reconstruction on Ventriculo-Arterial Coupling in Patients With Hypoplastic Left Heart Syndrome." Proceedings of the ASME 2012 Summer Bioengineering Conference. ASME 2012 Summer Bioengineering Conference, Parts A and B. Fajardo, Puerto Rico, USA. June 20–23, 2012. pp. 459-460. ASME. https://doi.org/10.1115/SBC2012-80262
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