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Updated: Jun 15, 2026
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Comprehensive evaluation of right ventricular function in children with different anatomical subtypes of hypoplastic
Colin Petko1, Peter Möller, Ulrike Hoffmann
1Children's Heart Centre, University Hospital of Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105 Kiel, Germany. petko@pedcard.uni-kiel.de
Insights
In hypoplastic left heart syndrome (HLHS) survivors, right ventricular (RV) function after Fontan surgery was similar between those with mitral/aortic atresia (MA/AA) and other HLHS subgroups. This finding suggests RV function is not impacted by LV size differences post-surgery.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Hypoplastic left heart syndrome (HLHS) survivors with larger left ventricular (LV) cavities may face poorer long-term outcomes.
- A diminished LV cavity, as seen in mitral and aortic atresia (MA/AA), is hypothesized to potentially preserve right ventricular (RV) function.
Purpose of the Study:
- To compare RV function in HLHS patients post-Fontan surgery.
- To investigate if the presence of MA/AA and a negligible LV impacts RV function compared to other HLHS anatomical variations.
Main Methods:
- Retrospective echocardiographic evaluation of RV function in 42 HLHS children post-Fontan surgery.
- Utilized 2D, Doppler, and color tissue Doppler imaging.
- Compared patients with MA/AA (group 1, n=20) to other HLHS subgroups (group 2, n=22).
Main Results:
- The MA/AA group exhibited a smaller ascending aorta diameter and LV area at birth.
- The MA/AA group had a larger RV end-diastolic and end-systolic area post-Fontan.
- No significant differences in RV function parameters (MPI, TAPSE, RV FAC, myocardial velocities) were observed between the groups.
Conclusions:
- RV function in HLHS patients following Fontan surgery was comparable between the MA/AA subgroup and other HLHS anatomical variations.
- The anatomical differences in LV size did not translate to measurable differences in RV function in this cohort.
Background:
There is some evidence that hypoplastic left heart syndrome (HLHS) survivors with a larger left ventricular (LV) cavity may have poorer long-term outcome than those with mitral and aortic valve atresia (MA/AA) and negligible LV. A negative impact of the LV remnant on right ventricular (RV) function may contribute to this.
Methods:
We retrospectively evaluated RV function echocardiographically using 2D, Doppler and colour tissue Doppler techniques in 42 children with HLHS after Fontan surgery. Patients diagnosed with MA/AA at birth (group 1, n = 20) were compared to all the remaining anatomical subgroups of HLHS (group 2, n = 22).
Results:
The MA/AA group had a smaller diameter of the ascending aorta at birth (p<0.0001), smaller LV area (p<0.0001) and larger RV area at end-diastole (p = 0.004) and end-systole (p = 0.01) after Fontan. All parameters of RV function including the myocardial performance index, tricuspid annular plane systolic excursion, RV fractional area change and all regional colour Doppler derived myocardial velocities were not different between groups.
Conclusion:
In our cohort, RV function in HLHS after Fontan surgery was not different for the subgroup with MA/AA when compared to the remaining subgroups.
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