Changes in right ventricular geometry and heart rate early after hemi-Fontan procedure.
To document and quantitate changes in right ventricular (RV) geometry and heart rate, we prospectively examined 35 consecutive patients with hypoplastic left heart syndrome under steady-state conditions (chloral hydrate sedation) before and after a bidirectional cavopulmonary anastomosis (hemi-Fontan) procedure. Right ventricular end-diastolic volume (RVEDV) was calculated as the product of RV cavity areas in two orthogonal planes divided by RV maximal length in either plane. After the hemi-Fontan procedure, RVEDV decreased by 33% from 33 +/- 13 to 22 +/- 11 mL (mean +/- standard deviation). Indexed RVEDV decreased from 86 +/- 37 to 57 +/- 28 mL/m2. The RV wall thickness at the diaphragm in subcostal frontal view (RVWD) increased by only 11% from 8 +/- 0.2 to 9 +/- 0.2 mm (p = not significant), but RVWD/RVEDV increased by 111% from 0.36 +/- 0.22 to 0.76 +/- 0.69 mm/mL (p = 0.002). The RV anterior wall thickness in subcostal sagittal view (RVWA) increased by only 13% from 7 +/- 0.2 to 8 +/- 0.2 mm (p = not significant), but RVWA/RVEDV increased by 103% from 0.31 +/- 0.20 to 0.63 +/- 0.54 mm/mL (p = 0.002). In 11 of 35 patients (31%), resting heart rate did not change (118 +/- 14 versus 108 +/- 9 beats/min; p = not significant); however, in 24 of 35 patients (69%), heart rate increased significantly (108 +/- 9 versus 127 +/- 10 beats/min; p = 0.05). In conclusion, RV wall thickness is high before the hemi-Fontan procedure and increases slightly in the first postoperative week.(ABSTRACT TRUNCATED AT 250 WORDS)
Division of Cardiology, Children's Hospital of Philadelphia, PA 19104.
M A
MA
Seliem
J M
JM
Baffa
J M
JM
Vetter
S L
SL
Chen
A J
AJ
Chin
W I
WI
Norwood
D000714:Anastomosis, Surgical; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000601:surgery*; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D014683:Vena Cava, Superior / Q000601:surgery*; D016278:Ventricular Function, Right / Q000502:physiology*