Serial Assessment of Left Ventricular Diastolic Function After Fontan Procedure

Overview

Journal Heart

Date 2000 Mar 18

PMID 10722541

Citations 39

Authors

Y F Cheung

D J Penny

A N Redington

Affiliations

Soon will be listed here.

Abstract

Objective: To assess longitudinal changes in systemic ventricular diastolic function late after the Fontan procedure.

Design And Patients: Prospective study of 13 patients at 2.8 (2.0) years (early) and again at 11.4 (2.0) years (late) after the Fontan procedure by Doppler echocardiography with simultaneous ECG, phonocardiogram, and respirometer.

Setting: Tertiary paediatric cardiac centre.

Results: The isovolumic relaxation time (IVRT) was significantly longer, and E wave deceleration time, E and A wave velocities, and E:A velocity ratio were reduced compared to normal both early and late after the procedure. The mean (SD) z score of IVRT decreased significantly from +2.50 (1.00) to +1.24 (0.80) (p = 0.002), and the z score of the E wave deceleration time decreased from -1.69 (1.31) to -2.40 (1.47) (p = 0.03) during follow up. The A wave deceleration time also tended to decrease (early 80 (12) ms v late 73 (11) ms, p = 0.13) with increased follow up. There were no changes of the E and A wave velocities and E:A velocity ratio. The E wave velocity was inversely related to IVRT both early (r = -0.82, p = 0.001) and late (r = -0.59, p = 0.034) after the operation. The prevalence of diastolic flow during isovolumic relaxation decreased from 85% (11/13) to 38% (5/13) (p = 0.04), while that of mid diastolic flow increased from 23% (3/13) to 77% (10/13) (p = 0.02) between the two assessments.

Conclusions: Left ventricular diastolic function remains highly abnormal late after the Fontan procedure. The longitudinal changes demonstrated on follow up are compatible with reduction of left ventricular compliance in addition to persisting abnormalities of relaxation.

Citing Articles

How cardiac output is controlled in a Fontan circulation: an update.

Gewillig M, Salaets T, Van De Bruaene A, Van den Eynde J, Brown S Interdiscip Cardiovasc Thorac Surg. 2025; 40(2).

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Contemporary Management of the Failing Fontan.

Venkatesh P, Gao H, Abudayyeh I, Pai R, Varadarajan P J Clin Med. 2024; 13(11).

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Exercise Pathophysiology and Testing in Individuals With a Fontan Circulation.

Mahendran A, Katz D, Opotowsky A, Lubert A CJC Pediatr Congenit Heart Dis. 2023; 2(3):112-123.

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Comparison of cardiac function between single left ventricle and tricuspid atresia: assessment using echocardiography combined with computational fluid dynamics.

Chen L, Wu L, Zhao L, Zhang Z, Liu J, Hong W Front Pediatr. 2023; 11:1159342.

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Occult Diastolic Dysfunction and Adverse Clinical Outcomes in Adolescents and Young Adults With Fontan Circulation.

Peck D, Averin K, Khoury P, Veldhuis G, Alsaied T, Lubert A J Am Heart Assoc. 2022; 12(1):e026508.

PMID: 36565206 PMC: 9973593. DOI: 10.1161/JAHA.122.026508.

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