Diastolic asynchrony and myocardial dysfunction in patients with univentricular heart after Fontan operation
- 138 Downloads
We aimed to assess the existence of myocardial dysfunction and intra-univentricular diastolic asynchrony in patients after Fontan operation.
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.
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).
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.
KeywordsAsynchrony Diastolic function Fontan circulation Tissue Doppler imaging
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.
- 5.Senzaki H, Masutani S, Kobayashi J, Kobayashi T, Sasaki N, Asano H, Kyo S, Yokote Y, Ishizawa A. Ventricular afterload and ventricular work in Fontan circulation: comparison with normal two-ventricle circulation and single-ventricle circulation with blalock-taussig shunts. Circulation. 2002;105:2885–92.PubMedCrossRefGoogle Scholar
- 8.Schmitt B, Steendijk P, Ovroutski S, Lunze K, Rahmanzadeh P, Maarouf N, Ewert P, Berger F, Kuehne T. Pulmonary vascular resistance, collateral flow, and ventricular function in patients with a Fontan circulation at rest and during dobutamine stress. Circ Cardiovasc Imaging. 2010;3:623–31.PubMedCrossRefGoogle Scholar
- 16.Abd El Rahman MY, Hui W, Yigitbasi M, Dsebissowa F, Schubert S, Hetzer R, Lange PE, Abdul-Khaliq H. Detection of left ventricular asynchrony in patients with right bundle branch block after repair of tetralogy of Fallot using tissue-Doppler imaging-derived strain. J Am Coll Cardiol. 2005;45:915–21.PubMedCrossRefGoogle Scholar
- 18.Rentzsch A, Abd El Rahman MY, Hui W, Helweg A, Ewert P, Gutberlet M, Lange PE, Berger F, Abdul-Khaliq H. Assessment of myocardial function of the systemic right ventricle in patients with D-transposition of the great arteries after atrial switch operation by tissue Doppler echocardiography. Z Kardiol. 2005;94:524–31.PubMedCrossRefGoogle Scholar
- 19.Thibault B, Harel F, Ducharme A, White M, Frasure-Smith N, Roy D, Philippon F, Dorian P, Talajic M, Dubuc M, Gagne P, Guerra PG, Macle L, Rivard L, Khairy P. Evaluation of resynchronization therapy for heart failure in patients with a QRS duration greater than 120 ms (GREATER-EARTH) trial: rationale, design, and baseline characteristics. Can J Cardiol. 2011;27:779–86.PubMedCrossRefGoogle Scholar
- 24.Kang SJ, Song JK, Yang HS, Song JM, Kang DH, Rhee KS, Nam GB, Choi KJ, Kim JJ, Kim YH. Systolic and diastolic regional myocardial motion of pacing-induced versus idiopathic left bundle branch block with and without left ventricular dysfunction. Am J Cardiol. 2004;93:1243–6.PubMedCrossRefGoogle Scholar
- 25.Teske AJ, De Boeck BW, Melman PG, Sieswerda GT, Doevendans PA, Cramer MJ. Echocardiographic quantification of myocardial function using tissue deformation imaging, a guide to image acquisition and analysis using tissue Doppler and speckle tracking. Cardiovasc Ultrasound. 2007;5:27.PubMedCrossRefGoogle Scholar
- 26.Yuda S, Inaba Y, Fujii S, Kokubu N, Yoshioka T, Sakurai S, Nishizato K, Fujii N, Hashimoto A, Uno K, Nakata T, Tsuchihashi K, Miura T, Ura N, Natori H, Shimamoto K. Assessment of left ventricular ejection fraction using long-axis systolic function is independent of image quality: a study of tissue Doppler imaging and m-mode echocardiography. Echocardiography (Mount Kisco, N.Y.). 2006;23:846–52.CrossRefGoogle Scholar