title: Impaired Single Right Ventricular Function Compared to Single Left Ventricles during the Early Stages of Palliation: A Longitudinal Study.
abstract: BACKGROUND
  Single right ventricles (SRV) are postulated to be disadvantaged compared with single left ventricles (SLV). We compared the evolution of SRV versus SLV function during infancy using conventional measures and speckle-tracking echocardiography (STE). We hypothesized that the SRV is mechanically disadvantaged during early infancy.
  
  
  METHODS
  SRVs (n = 32) were compared with SLVs (n = 16) at the neonatal (presurgery) and pre-bidirectional cavopulmonary anastomosis (pre-BCPA) stages. Functional measures (fractional area change, indexed ventricular annular plane systolic excursion [iVAPSE], isovolumic acceleration [IVA], myocardial performance index, E and A velocities, tissue Doppler imaging annular velocities and STE-measured global longitudinal and circumferential strain, strain rate [SR], and early diastolic SR [EDSR]) were compared between SRV and SLV at each stage and between presurgery and pre-BCPA.
  
  
  RESULTS
  Compared with SLV, presurgery SRV had lower circumferential strain (-10.6% vs -16.5%; P = .0002) and EDSR (1.41%/sec vs 2.13%/sec; P = .001). Pre-BCPA SRV had decreased IVA (1.2 vs 2.1 m/sec2; P = .006): longitudinal strain (-15.3% vs -19.1%; P = .001), SR (-0.97%/sec vs -1.53%/sec; P = .0001), EDSR (1.5%/sec vs 2.1%/sec; P = .001); circumferential strain (-10.6% vs -14.9%; P = .002), SR (-0.8%/sec vs -1.21%/sec; P = .0001), and EDSR (1.3%/sec vs 1.8%/sec; P = .009). SRV showed reduction of iVAPSE, IVA, s', e', a' velocities, longitudinal strain, SR, EDSR, and circumferential SR (P < .05) from presurgery to pre-BCPA, while circumferential strain was unchanged. SLV showed no significant change in these parameters during this interval.
  
  
  CONCLUSIONS
  The progressive reduction in SRV longitudinal and circumferential function suggests that SRV may have a mechanical disadvantage from birth and progressive impairment with age.
authors.affiliation: Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Somjate
authors.initials: S
authors.lastname: Suntratonpipat
authors.affiliation: Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Nee S
authors.initials: NS
authors.lastname: Khoo
authors.affiliation: Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Timothy
authors.initials: T
authors.lastname: Colen
authors.affiliation: Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alhabdan
authors.affiliation: Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Dongngan
authors.initials: D
authors.lastname: Troung
authors.affiliation: Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Norazah
authors.initials: N
authors.lastname: Zahari
authors.affiliation: University of Nebraska College of Medicine/Children's Hospital and Medical Center, Omaha, Nebraska.
authors.forename: Shelby
authors.initials: S
authors.lastname: Kutty
authors.affiliation: Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Smallhorn
authors.affiliation: Division of Pediatric Cardiology, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada. Electronic address: etham@ualberta.ca.
authors.forename: Edythe B
authors.initials: EB
authors.lastname: Tham
mesh_terms: D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D010166:Palliative Care / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery
keywords: Echocardiography; Single ventricle; Speckle-tracking imaging; Strain; Ventricular function