Myocardial Protection and Support in Cyanotic Congenital Heart Disease

Lay Summary: We proposed to advance understanding of ventricular stiffness in palliative surgery for single ventricle, and to use this knowledge to develop clinical trials to improve surgical outcomes in these patients. The funds received were employed intraoperatively in initial clinical studies and to improve methods for conducting these studies. The support provided by our grant led to publication of three papers dealing with ventricular stiffness (1,2,4) and to one developing improved methods for measuring stiffness (3). The realization that perioperative diastolic and systolic dysfunction might be caused by ventricular dyssynchrony led us to examine perioperative cardiac resynchronization
by temporary biventricular pacing in adults (5-7).

 

Success of biventricular pacing in adults with aortic valve disease (7) led us to examine multisite ventricular pacing in children with single ventricle physiology undergoing stage II and III palliative surgery (8,9). An ongoing preliminary clinical trial in nine patients has been very promising and encouraging (9), and we are currently pursuing additional funding to enhance and complete this study.

 

Clinical research sometimes results in rapid and dramatic progress, but some of the more complex issues require vision, persistence and patience to achieve success. The role of abnormal diastolic stiffness in surgery for single ventricle remains an important issue in clinical medicine.