Systemic ventricular morphology-associated increased QRS duration compromises the ventricular mechano-electrical and energetic properties long-term after the Fontan operation.
OBJECTIVE
To evaluate the impact of systemic ventricular (SV) morphology on mechano-electrical interaction (MEI) and compare the results with clinical profiles in Fontan patients.


BACKGROUND
Abnormal ventricular MEI causes systolic dysfunction of the right and left ventricles (RV, LV).


METHODS
We evaluated serial changes (up to 15 years post-Fontan operation) in QRS duration (QRS-d, ms), catheterization-based hemodynamics and SV performance in 77 patients and compared them with 36 referents.


RESULTS
Preoperative QRS-d was wider in the Fontan patients (86+/-14 vs. 64+/-9, p<0.001) and steadily increased for the next 15 years (107+/-25 vs. 85+/-9, p<0.001). QRS-d was wider in non-LV type SV patients than those with LV morphology (p<0.05) with a positive association with age at repair (p<0.001). SV contractility (Ees) improved in the RV and LV groups (p<0.05), during the next 10-year Ees, ventriculoarterial coupling (Ea/Ees) and ventricular efficiency (SW/PVA) were superior in the LV group. QRS-d and its long-term change correlated with the corresponding SV volume and change (p<0.01), respectively, while the immediate postoperative volume reduction did not result in the QRS-d shortening. QRS-d correlated with Ees, Ea/Ees, SW/PVA, and peak oxygen uptake (VO(2)) (p<0.001) and QRS-d was one of the main determinants of peak VO(2) (r=-0.48, p<0.001).


CONCLUSIONS
SV morphology-associated wide QRS-d compromises the MEI as well as energetic properties long-term after the Fontan operation, especially in non-LV type patients.
Ohuchi
Hideo
H
Department of Pediatrics, National Cardiovascular Center, Osaka, Japan. hohuchi@hsp.ncvc.go.jp
Miyazaki
Aya
A
Wakisaka
Yuko
Y
Watanabe
Ken-ichi
K
Kishiki
Kanako
K
Yamada
Osamu
O
Yagihara
Toshikatsu
T
Echigo
Shigeyuki
S
D000293:Adolescent; D002304:Cardiac Pacing, Artificial / Q000379:methods; D002648:Child; D002675:Child, Preschool; D018729:Fontan Procedure / Q000009:adverse effects* / Q000639:trends*; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000473:pathology* / Q000503:physiopathology*; D055815:Young Adult