Serial assessment of left ventricular diastolic function after Fontan procedure.
OBJECTIVE
To assess longitudinal changes in systemic ventricular diastolic function late after the Fontan procedure.


METHODS
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.


METHODS
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.
Cheung
Y F
YF
Great Ormond Street Hospital for Children NHS Trust and Institute of Child Health, University of London WC1N 3JH, UK.
Penny
D J
DJ
Redington
A N
AN
D001783:Blood Flow Velocity; D002648:Child; D002675:Child, Preschool; D003971:Diastole; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006801:Humans; D007223:Infant; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D016277:Ventricular Function, Left