title: Atrial and ventricular mechanics in patients after Fontan-type procedures: atriopulmonary connection versus extracardiac conduit.
abstract: BACKGROUND
  Differences in systemic venous flow dynamics and energy losses exist in various Fontan-type procedures, which may affect atrial and ventricular filling. The aim of this study was to test the hypothesis that atrial and ventricular mechanics differ between two types of Fontan procedures, atriopulmonary connection (APC) and extracardiac conduit, which have distinctly different systemic venous hemodynamics.
  
  
  METHODS
  This was a cross-sectional, case-control study of 28 Fontan patients (13 with APC, 15 with extracardiac conduit) aged 19.8 ± 6.5 years and 26 healthy controls. Atrial and systemic ventricular myocardial deformation was determined using speckle-tracking echocardiography, while ventricular volumes and systolic dyssynchrony index were assessed using three-dimensional echocardiography.
  
  
  RESULTS
  Compared with controls, patients had significantly lower values of global ventricular longitudinal, circumferential, and radial systolic strain in all three directions, reduced systolic and early diastolic strain rates (SRs) in more than one dimension, lower ejection fractions, and worse ventricular dyssynchrony. For atrial deformation, patients had lower global and positive strain and conduit and reservoir SRs and delayed electromechanical coupling. Among patients, those with APC had significantly lower ventricular longitudinal strain and early diastolic SRs, worse ventricular dyssynchrony, and reduced atrial positive and negative strain and conduit and active contractile SRs. Atrial global strain (r = 0.60, P = .001) and conduit SR (r = 0.49, P = .008) correlated positively with systemic ventricular early diastolic SR.
  
  
  CONCLUSIONS
  Atrial and ventricular mechanics are impaired in patients after Fontan-type operation, which is worse with APC than extracardiac conduit.
authors.affiliation: Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
authors.forename: Shu-Juan
authors.initials: SJ
authors.lastname: Li
authors.affiliation: Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
authors.forename: Sophia J
authors.initials: SJ
authors.lastname: Wong
authors.affiliation: Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. Electronic address: xfcheung@hkucc.hku.hk.
authors.forename: Yiu-fai
authors.initials: YF
authors.lastname: Cheung
mesh_terms: D000293:Adolescent; D016275:Atrial Function; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D018754:Ventricular Dysfunction / Q000453:epidemiology; D016276:Ventricular Function; D055815:Young Adult
keywords: Atrium; Cardiac mechanics; Fontan procedure; Speckle-tracking echocardiography; Ventricle