Ventricular performance before and after Fontan repair for univentricular atrioventricular connection: angiographic and radionuclide assessment

Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.

OBJECTIVES. This study was designed to evaluate changes in ventricular volume, mass and cardiac function before and after creation of an atrial to pulmonary connection in patients with a univentricular atrioventricular connection. BACKGROUND. Intact systolic and diastolic performance is critical for successful establishment of an atrial dependent circulation, and few studies are available comparing cardiac performance before and after creation. METHODS. With the use of radionuclide blood pool imaging and ventricular cineangiography, 54 patients (mean age 6.4 +/- 3.4 years) were studied. Twenty-eight patients were investigated preoperatively and 36 greater than 1 year after repair and compared with a control population. RESULTS. Before operation, end-diastolic volume and wall mass were significantly increased compared with those of control subjects; however, the mass/volume ratio was normal (1.08 +/- 0.31 g/ml for the preoperative group; 0.97 +/- 0.19 for control subjects). Although end-diastolic volume returned to normal after the procedure, wall mass remained elevated and contributed to an elevated mass/volume ratio (1.20 +/- 0.38 g/ml). After the procedure, systemic vascular resistance index was significantly elevated compared with that before surgery or with that of control subjects (1,199 +/- 373, 2,120 +/- 645, 1,556 +/- 275 dynes.s.cm-5.m2: pre- and postrepair and control subjects, respectively). Radionuclide studies demonstrated that preoperative ejection fraction (52 +/- 9, 50 +/- 9, 60 +/- 8%), peak ejection (2.58 +/- 0.66, 2.95 +/- 0.81, 3.73 +/- 0.70 EDV/s) and peak filling rates (2.84 +/- 0.75, 2.75 +/- 0.79, 3.84 +/- 0.51 end-diastolic volumes [EDV/s]) were significantly reduced compared with those of control subjects and remained so after surgery. CONCLUSIONS. These data suggest that systolic and diastolic function is depressed preoperatively in these patients, remains unchanged after the creation of an atrial-dependent circulation and is associated with an increased systemic vascular resistance. Long-term issues addressing preservation of cardiac function need to be prospectively studied.

This article has been cited by other articles:

				M. Gewillig, S. C. Brown, B. Eyskens, R. Heying, J. Ganame, W. Budts, A. L. Gerche, and M. Gorenflo The Fontan circulation: who controls cardiac output? Interact CardioVasc Thorac Surg, March 1, 2010; 10(3): 428 - 433. [Abstract] [Full Text] [PDF]

				Y. Kotani, S. Kasahara, Y. Fujii, K. Yoshizumi, Y. Oshima, S.-i. Otsuki, T. Akagi, and S. Sano Clinical outcome of the Fontan operation in patients with impaired ventricular function Eur J Cardiothorac Surg, October 1, 2009; 36(4): 683 - 687. [Abstract] [Full Text] [PDF]

				H. Senzaki, S. Masutani, H. Ishido, M. Taketazu, T. Kobayashi, N. Sasaki, H. Asano, T. Katogi, S. Kyo, and Y. Yokote Cardiac Rest and Reserve Function in Patients With Fontan Circulation J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2528 - 2535. [Abstract] [Full Text] [PDF]

				U. K. Chowdhury, B. Airan, S. S. Kothari, S. Talwar, A. Saxena, R. Singh, G. K. Subramaniam, K. K. Pradeep, C. D. Patel, and P. Venugopal Specific Issues After Extracardiac Fontan Operation: Ventricular Function, Growth Potential, Arrhythmia, and Thromboembolism Ann. Thorac. Surg., August 1, 2005; 80(2): 665 - 672. [Abstract] [Full Text] [PDF]

				U. K. Chowdhury, P. K. Mishra, R. Sharma, B. Airan, G. K. Subramaniam, S. S. Kothari, A. Bhan, C. D. Patel, and P. Venugopal Postoperative assessment of the univentricular repair by dynamic radionuclide studies Ann. Thorac. Surg., August 1, 2004; 78(2): 658 - 665. [Abstract] [Full Text] [PDF]

				Y. Tanoue, A. Sese, Y. Imoto, and K. Joh Ventricular mechanics in the bidirectional glenn procedure and total cavopulmonary connection Ann. Thorac. Surg., August 1, 2003; 76(2): 562 - 566. [Abstract] [Full Text] [PDF]

				G. Szabo, V. Buhmann, A. Graf, S. Melnitschuk, S. Bahrle, C. F. Vahl, and S. Hagl Ventricular energetics after the Fontan operation: Contractility-afterload mismatch J. Thorac. Cardiovasc. Surg., May 1, 2003; 125(5): 1061 - 1069. [Abstract] [Full Text] [PDF]

				G Agnoletti, A Borghi, G Vignati, and G C Crupi Fontan conversion to total cavopulmonary connection and arrhythmia ablation: clinical and functional results Heart, February 1, 2003; 89(2): 193 - 198. [Abstract] [Full Text] [PDF]

				H. Senzaki, S. Masutani, J. Kobayashi, T. Kobayashi, N. Sasaki, H. Asano, S. Kyo, Y. Yokote, and A. Ishizawa Ventricular Afterload and Ventricular Work in Fontan Circulation: Comparison With Normal Two-Ventricle Circulation and Single-Ventricle Circulation With Blalock-Taussig Shunts Circulation, June 18, 2002; 105(24): 2885 - 2892. [Abstract] [Full Text] [PDF]

				Y. Tanoue, A. Sese, Y. Ueno, K. Joh, and T. Hijii Bidirectional Glenn Procedure Improves the Mechanical Efficiency of a Total Cavopulmonary Connection in High-Risk Fontan Candidates Circulation, May 1, 2001; 103(17): 2176 - 2180. [Abstract] [Full Text] [PDF]

				A. A. Kouatli, J. A. Garcia, T. M. Zellers, E. M. Weinstein, and L. Mahony Enalapril Does Not Enhance Exercise Capacity in Patients After Fontan Procedure Circulation, September 2, 1997; 96(5): 1507 - 1512. [Abstract] [Full Text]

				J. Rychik, M. L. Jacobs, and W. I. Norwood Jr Acute changes in left ventricular geometry after volume reduction operation Ann. Thorac. Surg., November 1, 1995; 60(5): 1267 - 1274. [Abstract] [PDF]

				E. Magosso, S. Cavalcanti, and M. Ursino Theoretical analysis of rest and exercise hemodynamics in patients with total cavopulmonary connection Am J Physiol Heart Circ Physiol, March 1, 2002; 282(3): H1018 - H1034. [Abstract] [Full Text] [PDF]