Clinical InvestigationCongenital Heart DiseaseThe Assessment of Atrial Function in Single Ventricle Hearts from Birth to Fontan: A Speckle-Tracking Study by Using Strain and Strain Rate
Section snippets
Population
This was a cross-sectional study, between 2007 and 2010, of patients with SV physiology at the Stollery Children's Hospital, Edmonton, Alberta, Canada, and the Children's Hospital and Medical Center, Omaha, Nebraska. Patients with functionally single left or right ventricle hearts in sinus rhythm were prospectively recruited at a single time point at any 4 surgical stages: (1) before their first procedure (presurgery): i.e., Norwood-Sano for hypoplastic left ventricle and modified
Study Population
Eighty-one patients with functionally single right (n = 55) or left (n = 26) ventricles were prospectively recruited at 4 surgical stages: (1) presurgery, 22; (2) pre-BCPA, 23; (3) pre-Fontan, 22; and (4) post-Fontan, 14. Of 51 controls, there were 14 neonates for presurgery comparison (Norm I), 13 infants for pre-BCPA (Norm II), 12 children for pre-Fontan (Norm III), and 12 children for post-Fontan (Norm IV). Eight patients were excluded secondary to inadequate deformation tracking of the
Discussion
The main findings of this study were that the SV atrium increased size, reduced reservoir function and reduced conduit function, and an increased reliance on atrial active function for ventricular filling. These differences are present before any surgical intervention and remain abnormal at each stage of surgical palliation. The SV atrial mechanics deviate significantly from expected normal early childhood maturational changes and appear to parallel those of an atrium that is facing early
Conclusion
The atrium in SV hearts is dilated, has deceased atrial compliance, decreased early diastolic emptying, and an increased reliance on active atrial contraction for ventricular filling. These changes are present before any surgical intervention and remain abnormal across the staged surgical palliation. The atrial mechanics in SV hearts deviate significantly from expected normal early childhood maturational changes and appear to parallel those of atrium facing early ventricular diastolic
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