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Published on: July 11, 2013
Angiographic demonstration of incoordinate motion of the ventricular wall after the Fontan operation
1Department of Paediatric Cardiology, Royal Brompton National Heart and Lung Hospital, London.
Insights
The Fontan operation commonly leads to impaired ventricular relaxation in patients with single ventricle physiology. While abnormal contraction was frequent before surgery, abnormal relaxation significantly increased post-Fontan procedure.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The Fontan operation is a palliative procedure for complex single-ventricle congenital heart defects.
- Assessing systemic ventricular function is crucial for long-term outcomes after Fontan palliation.
Purpose of the Study:
- To evaluate regional wall motion abnormalities of the systemic ventricle in patients following the Fontan operation.
- To compare ventricular contraction and relaxation patterns before and after the Fontan procedure.
Main Methods:
- Systemic ventricular angiograms from 15 post-Fontan patients and 11 unoperated patients with univentricular atrioventricular connection were analyzed.
- Digital frame-by-frame analysis was performed using strict criteria to identify abnormal wall motion.
Main Results:
- Incoordinate ventricular contraction was observed in 5/11 pre-Fontan patients and 4/15 post-Fontan patients (not significant).
- Incoordinate ventricular relaxation was present in only 3/11 pre-Fontan patients but significantly increased to 12/15 post-Fontan patients (p < 0.01).
Conclusions:
- Incoordinate ventricular contraction is common in patients with univentricular atrioventricular connections, both before and after the Fontan operation.
- The Fontan operation is a significant cause of incoordinate ventricular relaxation, which is rare in the pre-operative state.
Objective:
To study regional wall motion of the systemic ventricle in patients after the Fontan operation.
Design And Patients:
Systemic ventricular angiograms of 15 patients after the Fontan operation and of 11 unoperated patients with a univentricular atrioventricular connection were digitised frame by frame. Strict criteria for abnormal wall motion were used so that minor abnormalities were not considered.
Results:
Incoordinate contraction of the ventricular wall was found in five of the 11 patients before and in four of the 15 patients after the Fontan operation (NS). Only three of the 11 patients before the Fontan operation, showed incoordination of ventricular relaxation, but incoordinate relaxation was seen in 12 of the 15 patients after operation (p less than 0.01).
Conclusions:
Whereas incoordination of ventricular contraction was common in patients with a univentricular atrioventricular connection, before or after the Fontan operation, incoordinate relaxation of the ventricular wall was a common consequence of the Fontan operation and was rare in patients before operation.
