The relationship between ventricular hypertrophy and clinical outcome in patients with double inlet left ventricle after atrial to pulmonary anastomosis

T. Akagi, L. N. Benson, W. G. Williams, R. M. Freedom

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

To clarify differences between pre- and postoperative volumetric and hemodynamic variables from patients with clinically good and poor outcomes after a Fontan procedure, 40 patients with univentricular heart (double inlet left ventricle) (mean age: 5.7 ± 3.3 years) were studied using the ventricular cineangiography. According to postoperative clinical findings, patients were classified into two groups: 26 patients with good outcomes and 14 patients with poor outcomes (including five with early and two with intermediate deaths) and compared with a control population. Age at surgery, pre-operative cardiac index, wall mass and systolic ejection phase parameters were not different between the two patient groups, however, end-diastolic volume index in poor outcomes was significantly smaller than those with good outcomes (100 ± 24, 78 ± 22, 64 ± 14 ml/m2: good, poor outcomes and controls, respectively, p < 0.05), and the mass/volume ratio in this group significantly elevated (1.00 ± 0.18, 1.19 ± 0.33, 0.97 ± 0.19 g/ml, p < 0.05). Postoperatively, both ventricular volume and mass in good outcomes returned toward the normal and the mass/volume ratio remained within normal range (1.07 ± 0.22). In contrast, the hypertrophied ventricular mass in those patients with poor outcomes did not decrease in parallel with ventricular volume, thus contributing to a further increased ratio (1.48 ± 0.19). Although there were no significant differences between pre-operative hemodynamic variables among the two groups, the mass/volume ratio in those with poor outcomes was increased pre-operatively and further increased after the Fontan procedure due to rapid and acute reduction of preload. The unbalanced mass/volume ratio reflecting inappropriate hypertrophy in this setting seemingly contributes to the poor prognosis due to diastolic filling abnormalities.

Original languageEnglish
Pages (from-to)220-227
Number of pages8
JournalHerz
Volume17
Issue number4
Publication statusPublished - Jan 1 1992
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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