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Diastolic asynchrony and myocardial dysfunction in patients with univentricular heart after Fontan operation

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Abstract

Background

We aimed to assess the existence of myocardial dysfunction and intra-univentricular diastolic asynchrony in patients after Fontan operation.

Methods

Twenty patients after Fontan procedure and 30 age-matched controls were included in the study. The global function of the univentricular heart was analyzed by the Tei index. Regional myocardial velocities and strain of the univentricular heart including the rudimentary right ventricle (RV) were quantified by tissue Doppler imaging. Intra-univentricular or intra left ventricular (LV) diastolic delay was measured from the difference of diastolic intervals (time to peak early diastolic velocity), measured at LV lateral wall and the rudimental RV wall in patients, or LV lateral wall and the ventricular septum in controls.

Results

Compared to the control group, patients after Fontan operation had significantly elevated Tei index (0.24 ± 0.02 vs. 0.41 ± 0.1, p < 0.001). On the other hand, the regional myocardial velocities and strains of the univentricular heart including the rudimentary RV were significantly reduced (p < 0.001). Among patients, there was a significant correlation between the Tei index of the univentricular ventricle and rudimentary RV strain (r = −0.66, p = 0.01). The heart rate-corrected intra-univentricular diastolic delay was significantly prolonged among patients when compared to the intra-LV diastolic delay in controls (0.01 ± 0.9 vs. 1 ± 1.1, p = 0.005).

Conclusions

Myocardial dysfunctions and intra-univentricular diastolic asynchrony of the univentricular heart in patients after Fontan procedure are evident. The rudimentary RV in patients after Fontan procedure plays an important role in the determination of the global function of the univentricular heart.

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Acknowledgments

We are grateful to Anne M. Gale ELS of the Deutsches Herzzentrum Berlin for editorial assistance. This work was supported by the Competence Network for Congenital Heart Defects, funded by the Federal Ministry of Education and Research (BMBF).

Conflict of interest

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

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Authors and Affiliations

  1. Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany

    Wei Hui, Mohamed Y. Abd El Rahman, Rita Schuck, Moustafa Yigitbasi, Stanislav Ovroutski, Fatima Lunze, Felix Berger & Hashim Abdul-Khaliq

  2. Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada

    Wei Hui

  3. Department of Pediatric Cardiology, Saarland University Hospital, Kirrberger Straße, 66421, Homburg/Saar, Germany

    Mohamed Y. Abd El Rahman, Rita Schuck, Axel Rentzsch & Hashim Abdul-Khaliq

  4. Department of Pediatrics and Pediatric Cardiology, Cairo University, Cairo, Egypt

    Mohamed Y. Abd El Rahman

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  1. Wei Hui
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Correspondence to Hashim Abdul-Khaliq.

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Hui, W., Abd El Rahman, M.Y., Schuck, R. et al. Diastolic asynchrony and myocardial dysfunction in patients with univentricular heart after Fontan operation. J Echocardiogr 11, 130–137 (2013). https://doi.org/10.1007/s12574-013-0191-z

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  • DOI: https://doi.org/10.1007/s12574-013-0191-z

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