Clinical InvestigationCongenital Heart DiseaseThree-Dimensional Mechanical Dyssynchrony and Myocardial Deformation of the Left Ventricle in Patients with Tricuspid Atresia after Fontan Procedure
Section snippets
Subjects
Twenty-five of the 32 Fontan patients with tricuspid atresia identified from the congenital heart disease database agreed to participate in this study. Five patients who required pacing or were not in sinus rhythm at the time of study were excluded. The following data were retrieved from the case records: cardiac diagnosis, need for systemic-to-pulmonary shunt insertion or pulmonary arterial banding, type of Fontan procedure, age at operation, and duration of follow-up since Fontan procedure.
Subjects
A total of 20 patients (seven men, 13 women; mean age, 23.5 ± 7.1 years) were studied. All but one patient had situs solitus with absent right atrioventricular connection, while the remaining patient had situs inversus totalis. The ventriculoarterial connection was concordant in 13 patients, double-outlet from the left ventricle in five, and discordant in two. Surgical interventions before the Fontan procedure included systemic-to-pulmonary arterial shunt insertion in nine patients, pulmonary
Discussion
The present study demonstrates a high prevalence of systemic LV mechanical dyssynchrony and impaired myocardial deformation in three dimensions in Fontan patients with tricuspid atresia. Additionally, LV systolic mechanical dyssynchrony was found to correlate negatively with magnitude and rate of myocardial deformation and cIB intensity. To our knowledge, this is the first study to quantify three-dimensional dyssynchronous contraction of functional single ventricles and to explore its
Conclusions
A high proportion of patients with tricuspid atresia after Fontan operation exhibit LV mechanical dyssynchrony, which may in part be related to myocardial fibrosis and has implications on myocardial deformation and global ventricular function.
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