Double Inlet Left VentricleDILV-SNCT03667144
Survival of Double Inlet Left Ventricle Patients Without Fontan Circulation
An observational study of Double Inlet Left Ventricle, run by University of Groningen.
Trial summary
Patients with univentricular hearts are currently palliated with the Fontan procedures. This results in an unphysiologic circulation with poor long-term survival. On the other hand there is a small, selected subgroup of patients with univentricular hearts of the double inlet left ventricle (DILV) type that survives up… Read more about this study
- Who is it for?
- Ages 12 years and older
- Conditions the study is for
- Double Inlet Left Ventricle
- How many people
- 15 participants
- Where
- No sites listed yet
- Study dates
- 3 Dec 2018to 1 Jun 2019
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 12 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: Included will be patients over the age of 12 with the diagnosis double inlet left ventricle, which have not undergone the Fontan trajectory. For the 4D MRI, patients with an MRI non-compatible pacemaker in situ will be excluded.
Who may be able to join
- Diagnosis double inlet left ventricle, established by echocardiograph or MRI
- Not undergone Fontan trajectory in the past
- Be of the age of 12 or older
- Written informed consent
Who cannot join
- previous (partial) cavopulmonary connection
- The following subjects will be excluded from the MRI part of the study, but will still be asked to participate in all the other parts:
- MRI non-compatible pacemaker in situ
Trial locations and contacts
No sites are listed yet.
About this study
Official title: Survival of Double Inlet Left Ventricle Patients Without Fontan Circulation: Intracardiac Anatomy and Hemodynamics, Functional Status and Quality of Life
Patients with univentricular hearts are currently palliated with the Fontan procedures. This results in an unphysiologic circulation with poor long-term survival. On the other hand there is a small, selected subgroup of patients with univentricular hearts of the double inlet left ventricle (DILV) type that survives up to old age without ever having undergone any Fontan procedures. Considering the relatively bleak data on long-term survival of DILV patients palliated with the Fontan procedure, it seems highly relevant to investigate and determine factors that allow a selection of unoperated patients to live to a comparatively high age without apparent major complaints. This might have an impact on how (and if, at all) certain univentricular patients are selected for operation in the future. For some, a different surgical procedure, or even therapeutic nihilism might be a more viable alternative.
The investigators hypothesise that favourable intracardiac streaming plays a role in making these patients viable: certain intracardiac anatomical characteristics allow for favourable flow patterns.
The primary objective of this study is to describe the intracardiac anatomy and hemodynamics of DILV patients without Fontan circulation using 4D MRI. Furthermore, the functional status and quality of life of these patients will be assessed.
Read the detailed description
Rationale: Patients with univentricular hearts are currently palliated with a sequence of operations known as the Fontan procedure. This results in an un-physiologic circulation with poor long-term survival. On the other hand there is a small, selected subgroup of patients with univentricular hearts of the double inlet left ventricle (DILV) type that survives up to old age without ever having undergone any Fontan procedure. Considering the relatively bleak data on long-term survival of DILV patients palliated with the Fontan procedure, it is highly relevant to investigate and determine factors that allow for a selection of unoperated patients to live to a comparatively high age without apparent major complaints. This might have an impact on how (and if, at all) certain univentricular patients will be selected for operation in the future. For some, a different surgical procedure, or even therapeutic nihilism might be a more viable alternative. The investigators hypothesize that favourable intracardiac streaming plays a role in making the unpalliated patients viable: certain intracardiac anatomical characteristics allow for favourable flow patterns, resulting in higher systemic oxygen saturations than expected by mixing pulmonary and systemic venous returns.
Objective: The primary objective of this study is to describe the intracardiac anatomy and hemodynamics of DILV patients without Fontan circulation using 4D MRI. Furthermore, the functional status and quality of life of these patients will be assessed and compared to a matched cohort of Fontan patients.
Study design: This will be an observational, cross-sectional study. The investigators aim to include all DILV patients without Fontan circulation known at the congenital heart disease referral centers in the Netherlands and Flanders. The Dutch patients will undergo one 4D MRI, a physical examination, cardiopulmonary exercise testing and have a blood sample taken at the University Medical Center Utrecht. The patients from the Flemish referral centers will undergo the same protocol at the University Medical Center Leuven. Furthermore, patients over the age of 18 will be asked to fill out a quality of life questionnaire.
Study population: Included will be patients over the age of 12 with the diagnosis double inlet left ventricle, which have not undergone the Fontan trajectory. For the 4D MRI, patients with an MRI non-compatible pacemaker in situ will be excluded.
Main study parameters/endpoints: This is primarily an explorative study aiming to describe the anatomy of unpalliated DILV hearts of patients without Fontan palliation. With 4D MRI, the hearts will be grouped according to the angular relationship of the two lines connecting the atrioventricular and the ventriculo-arterial valves. This angle can be divided into three categories: 1) parallel (i.e. 0°), 2) perpendicular (i.e. 90°) or 3) an in-between variant. Accordingly, flow patterns, ranging from linear to turbulent will be measured and correlated to the anatomical variants.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The burden and risks associated with participation in this study are minimal. Patients need to visit the site of investigation only once, and the tests done at the visit (i.e. 4D MR imaging, exercise and pulmonary function testing and blood sample) are part of standard medical care and as such pose negligible risk on the patients. The quality of life survey is not part of standard medical care and might be confrontational on a psychological level. It is, however, a widely used and scientifically approved survey, which aims to keep this burden very low. Due to the extremely low prevalence of the condition to be studied, it is of great importance to include every single patient, including children under the age of 18. Excluding children from this study would further decrease the sample size to a significantly smaller number, making it difficult to draw conclusions.
- Conditions
- Double Inlet Left Ventricle
- Keywords
- Double inlet left ventricle without Fontan circulation
What is being measured
The primary outcome is the main question the study is designed to answer.
Angle between atrioventricular and ventriculoarterial valves
This is primarily an explorative study aiming to describe the anatomy of unpalliated DILV hearts. With 4D MRI, the hearts will be grouped according to the angular relationship of the atrioventricular to the ventriculo-arterial valves. This angle can be divided into three categories: 1) parallel (i.e. 0°), 2) perpendicular (i.e. 90°) or 3) an in-between variant. Accordingly, flow patterns, ranging from linear to turbulent will be measured and correlated to the anatomical variants.
Measured: 1 day
Secondary outcomes (18)
New York Heart Association Functional Classification
NYHA functional class I to IV
Measured: 1 day
Peak VO2
peak oxygen uptake (VO2index) during exercise as well as peak VO2 as percentage of predicted (VO2 pred)
Measured: 1 day
Peripheral oxygen saturation
Oxygen saturation at rest, measured with oximetry
Measured: 1 day
Scores for Quality of life Adults
Quality of life survey overall scores, and scores in the subcategories measured with the Short Form (SF)36 (For patients 18 and older). The SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. The eight sections are:
vitality physical functioning bodily pain general health perceptions physical role functioning emotional role functioning social role functioning mental health
Measured: 1 day
Scores for Quality of life
Quality of life survey overall scores, and scores in the subcategories measured with PedsQL (for patients younger than 18). The 23-item PedsQL Generic Core Scales were designed to measure the core dimensions of health as delineated by the World Health Organization, as well as role (school) functioning. The 4 Multidimensional Scales are: Physical Functioning (8 items) Emotional Functioning (5 items), Social Functioning (5 items), School Functioning (5 items) The summary scores are: Total Scale Score (23 items), Physical Health Summary Score (8 items), Psychosocial Health Summary Score (15 items)
Measured: 1 day
Hematocrit
from venous blood
Measured: 1 day
Haemoglobin
from venous blood
Measured: 1 day
Creatinin
from venous blood
Measured: 1 day
eGFR
from venous blood
Measured: 1 day
high sensitive Troponin T
from venous blood
Measured: 1 day
NT-proBNP
from venous blood
Measured: 1 day
LDH
from venous blood
Measured: 1 day
ASAT
from venous blood
Measured: 1 day
ALAT
from venous blood
Measured: 1 day
Alkaline phosphatase
from venous blood
Measured: 1 day
Gamma-GT
from venous blood
Measured: 1 day
Galectin 3
from venous blood
Measured: 1 day
Bilirubin
from venous blood
Measured: 1 day
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Sep 2018
- Study start3 Dec 2018 (estimated)
- Primary completion1 Jun 2019 (estimated)
- Study completion1 Jun 2019 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for Double Inlet Left VentricleStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Cross-sectional
- Enrolment
- 15 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Groningen
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Sophie Meyer, University of Groningen
- Investigators
- Tjark Ebels, MD PhD, Principal investigator, University Medical Center Groningen
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03667144
- Sponsor's protocol ID
- NL59516.042.17
- Acronym
- DILV-S
- Status last verified
- Sep 2018
- First submitted
- 15 Aug 2018
- Last updated
- 12 Sep 2018
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Frescura C, Thiene G. The new concept of univentricular heart. Front Pediatr. 2014 Jul 7;2:62. doi: 10.3389/fped.2014.00062. eCollection 2014.
PubMed 25072035Cook AC, Anderson RH. The anatomy of hearts with double inlet ventricle. Cardiol Young. 2006 Feb;16 Suppl 1:22-6. doi: 10.1017/S1047951105002283. No abstract available.
PubMed 16401359Franklin RC, Spiegelhalter DJ, Anderson RH, Macartney FJ, Rossi Filho RI, Douglas JM, Rigby ML, Deanfield JE. Double-inlet ventricle presenting in infancy. I. Survival without definitive repair. J Thorac Cardiovasc Surg. 1991 May;101(5):767-76.
PubMed 2023434Gersony WM. Fontan operation after 3 decades: what we have learned. Circulation. 2008 Jan 1;117(1):13-5. doi: 10.1161/CIRCULATIONAHA.107.748566. No abstract available.
PubMed 18172049Poterucha JT, Anavekar NS, Egbe AC, Julsrud PR, Connolly HM, Ammash NM, Warnes CA. Survival and outcomes of patients with unoperated single ventricle. Heart. 2016 Feb;102(3):216-22. doi: 10.1136/heartjnl-2015-308440. Epub 2015 Dec 23.
PubMed 26701967Macartney FJ, Partridge JB, Scott O, Deverall PB. Common or single ventricle. An angiocardiographic and hemodynamic study of 42 patients. Circulation. 1976 Mar;53(3):543-54. doi: 10.1161/01.cir.53.3.543.
PubMed 1248087Wolff D, van Melle JP, Bartelds B, Ridderbos FS, Eshuis G, van Stratum EBHJ, Recinos SJ, Willemse BWM, Hillege H, Willems TP, Ebels T, Berger RMF. Fontan Circulation over Time. Am J Cardiol. 2017 Aug 1;120(3):461-466. doi: 10.1016/j.amjcard.2017.05.005. Epub 2017 May 11.
PubMed 28624095Wolff D, van de Wiel HBM, de Muinck Keizer ME, van Melle JP, Pieper PG, Berger RMF, Ebels T, Weijmar Schultz WCM. Quality of life and sexual well-being in patients with a Fontan circulation: An explorative pilot study with a mixed method design. Congenit Heart Dis. 2018 Mar;13(2):319-326. doi: 10.1111/chd.12576. Epub 2018 Mar 12.
PubMed 29532606
Study at a glance
From the registry record, last updated by the sponsor on 12 Sep 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Survival of Double Inlet Left Ventricle Patients Without Fontan Circulation: Intracardiac Anatomy and Hemodynamics, Functional Status and Quality of Life
- ClinicalTrials.gov ID
- NCT03667144
- Acronym / sponsor ID
- DILV-S / NL59516.042.17
- Conditions
- Double Inlet Left Ventricle
- Keywords
- Double inlet left ventricle without Fontan circulation
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 15 participants (estimated)
- Lead sponsor
- University of GroningenUniversity, hospital or other
- Study start
- 3 Dec 2018 (estimated)
- Primary completion
- 1 Jun 2019 (estimated)
- Study completion
- 1 Jun 2019 (estimated)
- First posted
- 12 Sep 2018 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Patients with univentricular hearts are currently palliated with the Fontan procedures. This results in an unphysiologic circulation with poor long-term survival. On the other hand there is a small, selected subgroup of patients with univentricular hearts of the double inlet left ventricle (DILV) type that survives up to old age without ever having undergone any Fontan procedures. Considering the relatively bleak data on long-term survival of DILV patients palliated with the Fontan procedure, it seems highly relevant to investigate and determine factors that allow a selection of unoperated patients to live to a comparatively high age without apparent major complaints. This might have an impact on how (and if, at all) certain univentricular patients are selected for operation in the future. For some, a different surgical procedure, or even therapeutic nihilism might be a more viable alternative.
The investigators hypothesise that favourable intracardiac streaming plays a role in making these patients viable: certain intracardiac anatomical characteristics allow for favourable flow patterns.
The primary objective of this study is to describe the intracardiac anatomy and hemodynamics of DILV patients without Fontan circulation using 4D MRI. Furthermore, the functional status and quality of life of these patients will be assessed.
Detailed description
Rationale: Patients with univentricular hearts are currently palliated with a sequence of operations known as the Fontan procedure. This results in an un-physiologic circulation with poor long-term survival. On the other hand there is a small, selected subgroup of patients with univentricular hearts of the double inlet left ventricle (DILV) type that survives up to old age without ever having undergone any Fontan procedure. Considering the relatively bleak data on long-term survival of DILV patients palliated with the Fontan procedure, it is highly relevant to investigate and determine factors that allow for a selection of unoperated patients to live to a comparatively high age without apparent major complaints. This might have an impact on how (and if, at all) certain univentricular patients will be selected for operation in the future. For some, a different surgical procedure, or even therapeutic nihilism might be a more viable alternative. The investigators hypothesize that favourable intracardiac streaming plays a role in making the unpalliated patients viable: certain intracardiac anatomical characteristics allow for favourable flow patterns, resulting in higher systemic oxygen saturations than expected by mixing pulmonary and systemic venous returns.
Objective: The primary objective of this study is to describe the intracardiac anatomy and hemodynamics of DILV patients without Fontan circulation using 4D MRI. Furthermore, the functional status and quality of life of these patients will be assessed and compared to a matched cohort of Fontan patients.
Study design: This will be an observational, cross-sectional study. The investigators aim to include all DILV patients without Fontan circulation known at the congenital heart disease referral centers in the Netherlands and Flanders. The Dutch patients will undergo one 4D MRI, a physical examination, cardiopulmonary exercise testing and have a blood sample taken at the University Medical Center Utrecht. The patients from the Flemish referral centers will undergo the same protocol at the University Medical Center Leuven. Furthermore, patients over the age of 18 will be asked to fill out a quality of life questionnaire.
Study population: Included will be patients over the age of 12 with the diagnosis double inlet left ventricle, which have not undergone the Fontan trajectory. For the 4D MRI, patients with an MRI non-compatible pacemaker in situ will be excluded.
Main study parameters/endpoints: This is primarily an explorative study aiming to describe the anatomy of unpalliated DILV hearts of patients without Fontan palliation. With 4D MRI, the hearts will be grouped according to the angular relationship of the two lines connecting the atrioventricular and the ventriculo-arterial valves. This angle can be divided into three categories: 1) parallel (i.e. 0°), 2) perpendicular (i.e. 90°) or 3) an in-between variant. Accordingly, flow patterns, ranging from linear to turbulent will be measured and correlated to the anatomical variants.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The burden and risks associated with participation in this study are minimal. Patients need to visit the site of investigation only once, and the tests done at the visit (i.e. 4D MR imaging, exercise and pulmonary function testing and blood sample) are part of standard medical care and as such pose negligible risk on the patients. The quality of life survey is not part of standard medical care and might be confrontational on a psychological level. It is, however, a widely used and scientifically approved survey, which aims to keep this burden very low. Due to the extremely low prevalence of the condition to be studied, it is of great importance to include every single patient, including children under the age of 18. Excluding children from this study would further decrease the sample size to a significantly smaller number, making it difficult to draw conclusions.
Study design
- Observational model
- Cohort
- Time perspective
- Cross-sectional
Who may qualify
- Ages
- 12 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- Study population
- Included will be patients over the age of 12 with the diagnosis double inlet left ventricle, which have not undergone the Fontan trajectory. For the 4D MRI, patients with an MRI non-compatible pacemaker in situ will be excluded.
Key inclusion criteria (4 listed)
- Diagnosis double inlet left ventricle, established by echocardiograph or MRI
- Not undergone Fontan trajectory in the past
- Be of the age of 12 or older
- Written informed consent
Key exclusion criteria (3 listed)
- previous (partial) cavopulmonary connection
- The following subjects will be excluded from the MRI part of the study, but will still be asked to participate in all the other parts:
- MRI non-compatible pacemaker in situ
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Angle between atrioventricular and ventriculoarterial valves
Time frame: 1 day
This is primarily an explorative study aiming to describe the anatomy of unpalliated DILV hearts. With 4D MRI, the hearts will be grouped according to the angular relationship of the atrioventricular to the ventriculo-arterial valves. This angle can be divided into three categories: 1) parallel (i.e. 0°), 2) perpendicular (i.e. 90°) or 3) an in-between variant. Accordingly, flow patterns, ranging from linear to turbulent will be measured and correlated to the anatomical variants.
18 secondary outcomes
New York Heart Association Functional Classification
Time frame: 1 day
Peak VO2
Time frame: 1 day
Peripheral oxygen saturation
Time frame: 1 day
Scores for Quality of life Adults
Time frame: 1 day
Scores for Quality of life
Time frame: 1 day
Hematocrit
Time frame: 1 day
Haemoglobin
Time frame: 1 day
Creatinin
Time frame: 1 day
eGFR
Time frame: 1 day
high sensitive Troponin T
Time frame: 1 day
NT-proBNP
Time frame: 1 day
LDH
Time frame: 1 day
ASAT
Time frame: 1 day
ALAT
Time frame: 1 day
Alkaline phosphatase
Time frame: 1 day
Gamma-GT
Time frame: 1 day
Galectin 3
Time frame: 1 day
Bilirubin
Time frame: 1 day
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Sep 2018.
- Background: PubMed 25072035Frescura C, Thiene G. The new concept of univentricular heart. Front Pediatr. 2014 Jul 7;2:62. doi: 10.3389/fped.2014.00062. eCollection 2014.
- Background: PubMed 16401359Cook AC, Anderson RH. The anatomy of hearts with double inlet ventricle. Cardiol Young. 2006 Feb;16 Suppl 1:22-6. doi: 10.1017/S1047951105002283. No abstract available.
- Background: PubMed 2023434Franklin RC, Spiegelhalter DJ, Anderson RH, Macartney FJ, Rossi Filho RI, Douglas JM, Rigby ML, Deanfield JE. Double-inlet ventricle presenting in infancy. I. Survival without definitive repair. J Thorac Cardiovasc Surg. 1991 May;101(5):767-76.
- Background: PubMed 18172049Gersony WM. Fontan operation after 3 decades: what we have learned. Circulation. 2008 Jan 1;117(1):13-5. doi: 10.1161/CIRCULATIONAHA.107.748566. No abstract available.
- Background: PubMed 26701967Poterucha JT, Anavekar NS, Egbe AC, Julsrud PR, Connolly HM, Ammash NM, Warnes CA. Survival and outcomes of patients with unoperated single ventricle. Heart. 2016 Feb;102(3):216-22. doi: 10.1136/heartjnl-2015-308440. Epub 2015 Dec 23.
- Background: PubMed 1248087Macartney FJ, Partridge JB, Scott O, Deverall PB. Common or single ventricle. An angiocardiographic and hemodynamic study of 42 patients. Circulation. 1976 Mar;53(3):543-54. doi: 10.1161/01.cir.53.3.543.
- Background: PubMed 28624095Wolff D, van Melle JP, Bartelds B, Ridderbos FS, Eshuis G, van Stratum EBHJ, Recinos SJ, Willemse BWM, Hillege H, Willems TP, Ebels T, Berger RMF. Fontan Circulation over Time. Am J Cardiol. 2017 Aug 1;120(3):461-466. doi: 10.1016/j.amjcard.2017.05.005. Epub 2017 May 11.
- Background: PubMed 29532606Wolff D, van de Wiel HBM, de Muinck Keizer ME, van Melle JP, Pieper PG, Berger RMF, Ebels T, Weijmar Schultz WCM. Quality of life and sexual well-being in patients with a Fontan circulation: An explorative pilot study with a mixed method design. Congenit Heart Dis. 2018 Mar;13(2):319-326. doi: 10.1111/chd.12576. Epub 2018 Mar 12.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Tjark Ebels, MD PhD principal investigator
University Medical Center Groningen
Questions about this trial
What is this clinical trial studying?
An observational study of Double Inlet Left Ventricle, run by University of Groningen.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 12 Sep 2018. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Sophie L Meyer, BSc (004917681033255, s.l.meyer@umcg.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Angle between atrioventricular and ventriculoarterial valves (time frame: 1 day). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03667144, which also lists 8 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Sep 2018.