Characteristics of Doppler myocardial echocardiography in patients with tricuspid atresia after total cavopulmonary connection with preserved systolic ventricular function.
BACKGROUND
Doppler myocardial echocardiography (DME) may be an excellent additional means of assessing determinants of systolic and diastolic ventricular function in patients with tricuspid atresia (TA) after total cavopulmonary connection (TCPC).


RESULTS
Thirty-three patients with TA and normal systolic shortening/ejection fraction (M-mode) after TCPC were studied by DME at a median age of 7.6 years (range 1.5-17 years). These results were compared to 16 age matched normal controls. Median time under a cavopulmonary shunt was 5.2 years (range 0.6-13.3 years). Isovolumic acceleration and isovolumic velocity did not differ significantly. All other systolic (S-wave acceleration-velocity and S-wave duration) and diastolic DME indices (E-deceleration-velocity, A-velocity and E/A ratio) were significantly lower in TCPC patients in comparison to normals (p<0.0001). Furthermore, isovolumic relaxation time (IRT) was significantly prolonged in the patient group (p<0.0001). Even though there was a significant correlation between the time of volume unloading and left ventricular end-diastolic diameter, exclusion of all patients with short period of volume unloading and relatively large systemic ventricles did not alter the results.


CONCLUSIONS
Patients with TA after TCPC and normal shortening and ejection fraction have normal isovolumic acceleration. Load dependent DME indices of systolic and diastolic function, however, were significantly reduced. These findings suggest that the described DME indices mirror the "normal" hemodynamics after TCPC in patients with TA. It needs to be assessed, whether this is an index of adverse prognosis in long-term surveillance of these patients.
Eicken
Andreas
A
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum, Technische Universität, München, Germany. eicken@dhm.mhn.de
Petzuch
Kurt
K
Marek
Jan
J
Vogel
Michael
M
Hager
Alfred
A
Vogt
Manfred
M
Skovránek
Jan
J
Busch
Raymonde
R
Schreiber
Christian
C
Schreiberd
Christian
C
Hess
John
J
D000293:Adolescent; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods; D015150:Echocardiography, Doppler; D006339:Heart Rate; D006801:Humans; D007223:Infant; D009200:Myocardial Contraction; D015588:Observer Variation; D011184:Postoperative Period; D011651:Pulmonary Artery / Q000601:surgery*; D013599:Systole; D013997:Time Factors; D018785:Tricuspid Atresia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D014684:Venae Cavae / Q000601:surgery*; D016276:Ventricular Function