Influence of ventricular morphology on diastolic filling performance in double-inlet ventricle after the fontan procedure

Teiji Akagi, Lee N. Benson, David L. Gilday, Judy Ash, Maria Green, William G. Williams, Robert M. Freedom

Research output: Contribution to journalArticle

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Abstract

Objectives. The purpose of this study was to define the influence of dominant chamber morphology on ventricular performance after the Fontan procedure in patients with double-inlet ventricle. Background Previous studies have reported the impact of ventricular morphology on preoperative ventricular performance and surgical outcome. However, the Influence on postoperative ventricular performance has not been addressed. Methods. Twenty-six clinically asymptomatic patients >1 year after repair (mean age at procedure 6.1 ± 3.7 years) were evaluated with ventricular cineangiography and radionuclide blood pool studies (18 with a dominant left ventricular morphology [LV group], 8 with a dominant right ventricular morphology [RV group]) and compared with normal control subjects. Results. Ventricular volume, mass and systolic variables were similar between patient groups. In the LV group, however, the mass/volume ratio was significantly elevated compared with values in control subjects (1.11 ± 0,28, 0.97 ± 0.19, p <0.05), whereas this ratio in the RV group (0.90 ± 0.11) was within the normal range and significantly lower than that in the LV group (p <0.05). Mean right atrial and pulmonary artery pressures in the RV group were significantly higher than those in the LV group (p <0.05). Peak filling rates (2.87 ± 0.70, 2.41 ± 1.15 and 3.84 ± 0.51 end-diastolic volume/s [LV and RV groups and control subjects, respectively]) were significantly lower in both groups than in control subjects (p <0.001), without intergroup difference. Conclusions. Ventricular filling abnormalities after atrial to pulmonary anastomosis are common regardless of the type of dominant ventricular morphology, and these abnormalities in patients with dominant right ventricular morphology do not coexist with ventricular hypertrophy. Such diastolic abnormalities may be related to either intrinsic myocardial or acquired factors, not to excessive hypertrophy alone. Those differences may become clinically more apparent with longer follow-up and may raise concerns over the long-term course.

Original languageEnglish
Pages (from-to)1948-1952
Number of pages5
JournalJournal of the American College of Cardiology
Volume22
Issue number7
DOIs
Publication statusPublished - 1993
Externally publishedYes

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Fontan Procedure
Hypertrophy
Cineangiography
Control Groups
Radioisotopes
Pulmonary Artery
Reference Values
Pressure
Lung

ASJC Scopus subject areas

  • Nursing(all)

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Influence of ventricular morphology on diastolic filling performance in double-inlet ventricle after the fontan procedure. / Akagi, Teiji; Benson, Lee N.; Gilday, David L.; Ash, Judy; Green, Maria; Williams, William G.; Freedom, Robert M.

In: Journal of the American College of Cardiology, Vol. 22, No. 7, 1993, p. 1948-1952.

Research output: Contribution to journalArticle

Akagi, Teiji ; Benson, Lee N. ; Gilday, David L. ; Ash, Judy ; Green, Maria ; Williams, William G. ; Freedom, Robert M. / Influence of ventricular morphology on diastolic filling performance in double-inlet ventricle after the fontan procedure. In: Journal of the American College of Cardiology. 1993 ; Vol. 22, No. 7. pp. 1948-1952.
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abstract = "Objectives. The purpose of this study was to define the influence of dominant chamber morphology on ventricular performance after the Fontan procedure in patients with double-inlet ventricle. Background Previous studies have reported the impact of ventricular morphology on preoperative ventricular performance and surgical outcome. However, the Influence on postoperative ventricular performance has not been addressed. Methods. Twenty-six clinically asymptomatic patients >1 year after repair (mean age at procedure 6.1 ± 3.7 years) were evaluated with ventricular cineangiography and radionuclide blood pool studies (18 with a dominant left ventricular morphology [LV group], 8 with a dominant right ventricular morphology [RV group]) and compared with normal control subjects. Results. Ventricular volume, mass and systolic variables were similar between patient groups. In the LV group, however, the mass/volume ratio was significantly elevated compared with values in control subjects (1.11 ± 0,28, 0.97 ± 0.19, p <0.05), whereas this ratio in the RV group (0.90 ± 0.11) was within the normal range and significantly lower than that in the LV group (p <0.05). Mean right atrial and pulmonary artery pressures in the RV group were significantly higher than those in the LV group (p <0.05). Peak filling rates (2.87 ± 0.70, 2.41 ± 1.15 and 3.84 ± 0.51 end-diastolic volume/s [LV and RV groups and control subjects, respectively]) were significantly lower in both groups than in control subjects (p <0.001), without intergroup difference. Conclusions. Ventricular filling abnormalities after atrial to pulmonary anastomosis are common regardless of the type of dominant ventricular morphology, and these abnormalities in patients with dominant right ventricular morphology do not coexist with ventricular hypertrophy. Such diastolic abnormalities may be related to either intrinsic myocardial or acquired factors, not to excessive hypertrophy alone. Those differences may become clinically more apparent with longer follow-up and may raise concerns over the long-term course.",
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AU - Williams, William G.

AU - Freedom, Robert M.

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N2 - Objectives. The purpose of this study was to define the influence of dominant chamber morphology on ventricular performance after the Fontan procedure in patients with double-inlet ventricle. Background Previous studies have reported the impact of ventricular morphology on preoperative ventricular performance and surgical outcome. However, the Influence on postoperative ventricular performance has not been addressed. Methods. Twenty-six clinically asymptomatic patients >1 year after repair (mean age at procedure 6.1 ± 3.7 years) were evaluated with ventricular cineangiography and radionuclide blood pool studies (18 with a dominant left ventricular morphology [LV group], 8 with a dominant right ventricular morphology [RV group]) and compared with normal control subjects. Results. Ventricular volume, mass and systolic variables were similar between patient groups. In the LV group, however, the mass/volume ratio was significantly elevated compared with values in control subjects (1.11 ± 0,28, 0.97 ± 0.19, p <0.05), whereas this ratio in the RV group (0.90 ± 0.11) was within the normal range and significantly lower than that in the LV group (p <0.05). Mean right atrial and pulmonary artery pressures in the RV group were significantly higher than those in the LV group (p <0.05). Peak filling rates (2.87 ± 0.70, 2.41 ± 1.15 and 3.84 ± 0.51 end-diastolic volume/s [LV and RV groups and control subjects, respectively]) were significantly lower in both groups than in control subjects (p <0.001), without intergroup difference. Conclusions. Ventricular filling abnormalities after atrial to pulmonary anastomosis are common regardless of the type of dominant ventricular morphology, and these abnormalities in patients with dominant right ventricular morphology do not coexist with ventricular hypertrophy. Such diastolic abnormalities may be related to either intrinsic myocardial or acquired factors, not to excessive hypertrophy alone. Those differences may become clinically more apparent with longer follow-up and may raise concerns over the long-term course.

AB - Objectives. The purpose of this study was to define the influence of dominant chamber morphology on ventricular performance after the Fontan procedure in patients with double-inlet ventricle. Background Previous studies have reported the impact of ventricular morphology on preoperative ventricular performance and surgical outcome. However, the Influence on postoperative ventricular performance has not been addressed. Methods. Twenty-six clinically asymptomatic patients >1 year after repair (mean age at procedure 6.1 ± 3.7 years) were evaluated with ventricular cineangiography and radionuclide blood pool studies (18 with a dominant left ventricular morphology [LV group], 8 with a dominant right ventricular morphology [RV group]) and compared with normal control subjects. Results. Ventricular volume, mass and systolic variables were similar between patient groups. In the LV group, however, the mass/volume ratio was significantly elevated compared with values in control subjects (1.11 ± 0,28, 0.97 ± 0.19, p <0.05), whereas this ratio in the RV group (0.90 ± 0.11) was within the normal range and significantly lower than that in the LV group (p <0.05). Mean right atrial and pulmonary artery pressures in the RV group were significantly higher than those in the LV group (p <0.05). Peak filling rates (2.87 ± 0.70, 2.41 ± 1.15 and 3.84 ± 0.51 end-diastolic volume/s [LV and RV groups and control subjects, respectively]) were significantly lower in both groups than in control subjects (p <0.001), without intergroup difference. Conclusions. Ventricular filling abnormalities after atrial to pulmonary anastomosis are common regardless of the type of dominant ventricular morphology, and these abnormalities in patients with dominant right ventricular morphology do not coexist with ventricular hypertrophy. Such diastolic abnormalities may be related to either intrinsic myocardial or acquired factors, not to excessive hypertrophy alone. Those differences may become clinically more apparent with longer follow-up and may raise concerns over the long-term course.

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