Journal of the American Society of Echocardiography
Clinical InvestigationCongenital Heart DiseaseSingle Right Ventricles Have Impaired Systolic and Diastolic Function Compared to Those of Left Ventricular Morphology
Section snippets
Study Population
Since 2007, we have conducted a longitudinal study to examine ventricular function in patients with hypoplastic left heart syndrome (HLHS). With further study of these patients, we expanded our patient population to include all patients with single ventricles at any surgical stage in 2009. For this cross-sectional study to compare SRV and SLV function, we selected patients with SLVs from this group, who were matched for surgical stage with patients with SRVs of similar ages by an observer who
Results
Of 86 eligible patients with functionally single-ventricle hearts at three different stages, 60 were matched for surgical stage to allow comparison between those with SRVs (n = 30) and those with SLVs (n = 30) as a group. Hence, there were 20 patients with either SRVs or SLVs at each of the pre-BCPA, pre-Fontan, and post-Fontan stages. Because of a larger proportion of patients with SRVs in our study group, some with SRVs were “unmatched” and thus not included in the study. There were no
Discussion
The single morphologic right ventricle has been hypothesized to have a poorer adaptation to ventricular volume overload during staged palliation surgery.2, 11, 12 This stems from reports of inadequate compensatory ventricular hypertrophy (insufficient mass/volume ratio), and results in abnormal SRV contractility and function, despite having similar ventricular volumes and ejection fractions to SLVs.11 Studies in the adult congenital population with systemic right ventricles or SRVs have found
Conclusions
Single ventricles with dominant morphologic right ventricles have impaired systolic and diastolic function compared with single morphologic left ventricles. Differences in PSSi suggest that relative myocardial ischemia may have a potential role in SRV impairment, while the impact of ventricular mechanical dyssynchrony was not apparent. Patients with SRVs were found to have poorer ventricular systolic performance at the pre-BCPA stage, while differences in diastolic function were more prominent
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2020, International Journal of CardiologyCitation Excerpt :S′ in the Hershenson's et al. study [15] was lower in patients with a dominant right single ventricle than in patients with dominant left ventricle. This observation was not confirmed by Kaneko et al. [13] and us, however there were also no differences in the rest of the analyzed echocardiographic parameters between patients with a dominant left and right single ventricles. One of the mechanisms responsible for worse contractility of the single right ventricle, than the left may be right ventricle susceptibility to coronary perfusion efficiency or indeed a coronary supply-and-demand mismatch.
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