title: Echocardiographic assessment of atrial properties in single ventricles vs. normal controls.
abstract: BACKGROUND
  Atrial function is increasingly being recognized as a significant factor in overall cardiac function in adults. Limited studies evaluating atrial properties exist in the pediatric congenital heart disease population. The goal of this study was to evaluate atrial properties in patients with single ventricle physiology after Fontan completion and compare these values with normal control patients.
  
  
  METHODS
  Echocardiograms were performed in patients with single ventricular physiology and in control patients. Tissue Doppler and blood flow measurements were obtained. Atrial fraction and atrial electromechanical values were calculated. Differences were assessed with one-way analysis of variance. Post hoc comparisons were performed with Tukey adjustment. P < .05 was considered significant.
  
  
  RESULTS
  No significant difference was present in age or heart rate between single ventricle and control patients. The single right ventricle tricuspid valve A wave (52.6 ± 14.5 vs. 36.7 ± 10.4 cm/s) and atrial fraction (39.2 ± 6.2 vs. 32.7 ± 7.7%) were significantly higher, and the E/A ratio (1.4 + 0.3 vs. 1.8 + 0.4), tricuspid valve E/A velocity-time integral (1.6 + 0.4 vs. 2.2 + 0.7 cm), and late diastolic annular value (5.3 + 1.5 vs. 8.7 + 1.4 cm/s) were significantly lower compared with the controls. The single left ventricle late diastolic annular velocity (4.2 + 1.0 vs. 6.7 + 1.3 cm/s) was significantly lower and atrial fraction was significantly higher compared with the controls (37.7 ± 12.5 vs. 29.8 ± 4.3%). There were no significant differences in atrial electromechanical measurements between groups, but the single right ventricle patients tended to have increased atrial dyssynchrony compared with controls.
  
  
  CONCLUSIONS
  Patients with single ventricle physiology after Fontan completion have differences in atrial properties when compared with normal controls. These differences may have important implications in their long-term outcomes. Further studies are necessary to determine the clinical significance of these findings.
authors.affiliation: The Heart Center, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio 43205, USA. jack.stines@nationwidechildrens.org
authors.forename: Jack R
authors.initials: JR
authors.lastname: Stines
authors.forename: Jared A
authors.initials: JA
authors.lastname: Hershenson
authors.forename: John
authors.initials: J
authors.lastname: Hayes
authors.forename: Carol A
authors.initials: CA
authors.lastname: Stefaniak
authors.forename: Karen M
authors.initials: KM
authors.lastname: Texter
authors.forename: Ali N
authors.initials: AN
authors.lastname: Zaidi
authors.forename: Clifford L
authors.initials: CL
authors.lastname: Cua
mesh_terms: D000704:Analysis of Variance; D016275:Atrial Function; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D018729:Fontan Procedure; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D009820:Ohio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right