Diastolic asynchrony and myocardial dysfunction in patients with univentricular heart after Fontan operation.
BACKGROUND
We aimed to assess the existence of myocardial dysfunction and intra-univentricular diastolic asynchrony in patients after Fontan operation.


METHODS
Twenty patients after Fontan procedure and 30 age-matched controls were included in the study. The global function of the univentricular heart was analyzed by the Tei index. Regional myocardial velocities and strain of the univentricular heart including the rudimentary right ventricle (RV) were quantified by tissue Doppler imaging. Intra-univentricular or intra left ventricular (LV) diastolic delay was measured from the difference of diastolic intervals (time to peak early diastolic velocity), measured at LV lateral wall and the rudimental RV wall in patients, or LV lateral wall and the ventricular septum in controls.


RESULTS
Compared to the control group, patients after Fontan operation had significantly elevated Tei index (0.24 ± 0.02 vs. 0.41 ± 0.1, p < 0.001). On the other hand, the regional myocardial velocities and strains of the univentricular heart including the rudimentary RV were significantly reduced (p < 0.001). Among patients, there was a significant correlation between the Tei index of the univentricular ventricle and rudimentary RV strain (r = -0.66, p = 0.01). The heart rate-corrected intra-univentricular diastolic delay was significantly prolonged among patients when compared to the intra-LV diastolic delay in controls (0.01 ± 0.9 vs. 1 ± 1.1, p = 0.005).


CONCLUSIONS
Myocardial dysfunctions and intra-univentricular diastolic asynchrony of the univentricular heart in patients after Fontan procedure are evident. The rudimentary RV in patients after Fontan procedure plays an important role in the determination of the global function of the univentricular heart.
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany.|Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Wei
W
Hui
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany.|Department of Pediatric Cardiology, Saarland University Hospital, Kirrberger Straße, 66421, Homburg/Saar, Germany.|Department of Pediatrics and Pediatric Cardiology, Cairo University, Cairo, Egypt.
Mohamed Y
MY
Abd El Rahman
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany.|Department of Pediatric Cardiology, Saarland University Hospital, Kirrberger Straße, 66421, Homburg/Saar, Germany.
Rita
R
Schuck
Department of Pediatric Cardiology, Saarland University Hospital, Kirrberger Straße, 66421, Homburg/Saar, Germany.
Axel
A
Rentzsch
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany.
Moustafa
M
Yigitbasi
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany.
Stanislav
S
Ovroutski
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany.
Fatima
F
Lunze
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany.
Felix
F
Berger
Department of Congenital Heart Disease, Deutsches Herzzentrum Berlin, Berlin, Germany. Hashim.Abdul-Khaliq@uniklinikum-saarland.de.|Department of Pediatric Cardiology, Saarland University Hospital, Kirrberger Straße, 66421, Homburg/Saar, Germany. Hashim.Abdul-Khaliq@uniklinikum-saarland.de.
Hashim
H
Abdul-Khaliq
Asynchrony; Diastolic function; Fontan circulation; Tissue Doppler imaging