Preserved regional atrial contractile function following extra-atrial rather than intra-atrial type Fontan operation: a tissue Doppler imaging study.
OBJECTIVE
To determine the univentricular and atrial function in patients following Fontan operation using tissue Doppler echocardiography (TDE).


METHODS
Hospital-based outpatient clinic and inpatient unit.


METHODS
Thirty-six patients (mean age 13 ys [2-34 ys]) after Fontan procedure and 30 healthy individuals matched for age and heart rate.


METHODS
Pulsed wave Doppler derived Tei index was determined for global univentricular function. Tissue-Doppler derived strain rate and strain were measured for regional ventricular function. Different planimetric approaches were used to evaluate the global atrial function. Strain rate was measured for regional atrial contractile function.


RESULTS
The Tei index, reflecting global univentricular function, was significantly higher in Fontan patients than in the control group (p<0.001). The regional ventricular contractile function, which was determined by TDE derived strain and strain rate, was significantly lower in Fontan patients than in healthy controls (p<0.001). The global atrial function evaluated planimetrically, and the regional atrial function assessed using the TDE strain rate, were significantly lower in Fontan patients than in normal controls (p<0.001, p<0.001, respectively). A comparison of different types of Fontan operations with extra-atrial or intra-atrial baffle showed a better regional left atrial wall strain rate in patients with extra-atrial baffle than with intra-atrial baffle.


CONCLUSIONS
Patients who have undergone the Fontan procedure may present with altered ventricular and atrial performance independent of whether the extra-atrial or intraatrial type Fontan operation was performed. However, the regional atrial contractile function seems to be better preserved following the extra-atrial type Fontan operation.
Lunze
Fatima I
FI
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin, Germany. flunze@dhzb.de
Hui
Wei
W
Abd El Rahman
Mohamed Y
MY
Alexi-Meskishvili
Vladimir
V
Hetzer
Roland
R
Lange
Peter E
PE
Berger
Felix
F
Abdul-Khaliq
Hashim
H
D000293:Adolescent; D000328:Adult; D016275:Atrial Function; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D005260:Female; D018729:Fontan Procedure / Q000379:methods; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D009200:Myocardial Contraction