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Browsing by Author "Ojala, Tiina"

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  • Risk factors for mortality in patients with hypoplastic left heart syndrome after the Norwood procedure 
    Selenius, Sabina; Ilvesvuo, Johanna; Ruotsalainen, Hanna; Mattila, Ilkka; Pätilä, Tommi; Helle, Emmi; Ojala, Tiina (2023)
    BACKGROUND: Several studies have reported mortality risk factors associated with hypoplastic left heart syndrome (HLHS). However, these data are ambiguous and mainly focused on the independent effect of these factors. We examined both the independent and the cumulative effect of preoperative risk factors for poor outcome in patients undergoing the Norwood procedure. Moreover, we studied the risk factors associated with prolonged initial hospital stay in these patients. METHODS: We performed a retrospective national 18-year observational study of preoperative risk factors for one-year, as well as total follow-up mortality or need for transplant in HLHS-patients (N=99) born in Finland between 1 January 2004 and 31 December 2021. RESULTS: Overall, one-year survival was 85.6%. In a multivariable analysis, major extracardiac anomaly and being small for gestational age were significant predictors of one-year mortality or need for transplant. Aortic atresia was a predictor of total follow-up mortality. When analyzing the cumulative effect, the presence of two risk factors was associated with higher mortality. CONCLUSIONS: HLHS remains the defect with the highest procedural risks for mortality in paediatric cardiac surgery. From a prognostic point of view, recognition of independent preoperative risk factors as well as the cumulative effect of risk factors for mortality is essential.
  • Systemic-to-pulmonary collateral flow associations with antegrade pulmonary flow in single ventricle patients: insights from cardiac magnetic resonance imaging 
    Yanovskiy, Anna; Martelius, Laura; Nyman, Nicolina; Vepsäläinen, Teemu; Mattila, Ilkka; Rahkonen, Otto; Ojala, Tiina (2024)
    Patients with a single ventricle physiology undergo staged palliative correction in childhood, typically culminating in total cavopulmonary connection (TCPC), where the pulmonary arteries are directly connected to the vena cavae. This results in a pulseless antegrade flow to the lungs. These patients often develop systemic-to- pulmonary collateral flow (SPCF), which may divert a significant portion of the aortic flow. The impact of SPCF on pulmonary antegrade flow remains a subject of debate. This retrospective study aimed to identify factors associated with SPCF using cardiac magnetic resonance (CMR) reports, and establish a cutoff value for the SPCF of the total pulmonary venous flow (SPCF%PV) indicating reduced antegrade pulmonary flow. Data from 158 CMR examinations of single ventricle patients, conducted between January 2017 and June 2021, were analyzed. 131 of the patients had undergone TCPC (post-TCPC) at the time of examination, while 27 patients were at the pre- TCPC stage. Results showed a significant decrease in SPCF%PV in the post-TCPC group compared to the pre-TCPC group, suggesting a spontaneous reduction in SPCF after TCPC. Factors associated with lower SPCF%PV included older age, higher antegrade pulmonary flow, and specific operative techniques during initial corrective surgery. For pre-TCPC patients, an SPCF%PV threshold of 42 %, and for post-TCPC patients 34 %, effectively identified reduced antegrade pulmonary flow. This study provides valuable insights into the relationship between SPCF and antegrade pulmonary flow in single ventricle patients, but further research is needed to influence clinical management and decision-making.

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