Regional ventricular wall motion abnormalities in tricuspid atresia after the fontan procedure

Teiji Akagi, Lee N. Benson, William G. Williams, Robert M. Freedom

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objectieves. The purpose of this study was to determine whether wall motion abnormalities are present before or after the Fontan procedure in patients with a univentricular heart of the left ventricular type with an absent right atrioventricular valve connection (tricuspid atresia) and to assess the impact of such abnormalities on ventricular performance and clinical outcome. Background. Normal systolic and diastolic ventricular (unction is critical for a successful Fontan repair. However, there have been no previous studies addressing the relation between regional ventricular function and hemodynamic factors. Methods. Thirty-seven pediatric patients were studied with biplane ventricular cineangiography. There were 20 male and 17 female patients whose mean age at the time of the Fontan operation was 6.5 ± 3.5 years (range 2.5 to 15.6). Eighteen patients were studied preoperatively, 25 at >1 year postoperatively and 6 serially. Wall motion was assessed by a centerline method. Normal ranges for wall motion and other variables were established from 25 normal subjects. Results. Wall motion abnormalities were observed in 2 of 18 patients preoperatively and in 11 of 25 patients postoperatively. Age at operation and ventricular volumes did not differ between postoperative patients who had normal (group I, 14 patients) or abnormal (group II, 11 patients) wall motion. However, ventricular mass and the mass/volume ratio were significantly greater and systolic variables and cardiac index were significantly lower in group II versus group I. Two patients in group I were considered to have a clinically poor outcome (persistent heart failure), and five in group II had heart failure, including one who died late. Conclusions. These observations suggest that postoperative regional wall motion abnormalities in this setting are not rare, may be related to excessive hypertrophy and may contribute to cardiac dysfunction and a poor clinical outcome.

Original languageEnglish
Pages (from-to)1182-1188
Number of pages7
JournalJournal of the American College of Cardiology
Volume22
Issue number4
DOIs
Publication statusPublished - Oct 1993
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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