Longitudinal changes in echocardiographic measures of ventricular function after Fontan operation

Area of Science:

• Pediatric Cardiology
• Cardiac Physiology
• Echocardiography

Background:

• Single ventricle heart disease (SVHD) patients undergo Fontan palliation.
• Ventricular function assessment after Fontan is crucial but longitudinal data are limited.
• Existing indices for ventricular function may not fully capture long-term changes.

Purpose of the Study:

• To evaluate longitudinal changes in ventricular function parameters after Fontan operation.
• To identify early echocardiographic markers of cardiac dysfunction in SVHD patients.
• To compare functional changes between patients with and without adverse outcomes.

Main Methods:

• Retrospective observational study of 40 patients post-Fontan operation.
• Echocardiographic parameters including fractional area change (FAC), TAPSE, MPI, s/d ratio, and myocardial strain/strain rate were measured.
• A composite endpoint of protein-losing enteropathy, plastic bronchitis, transplant, or death was defined.

Main Results:

• Mean ventricular function parameters were worse than expected for healthy controls.
• Global longitudinal strain rate increased (worsened) by 0.014/year (P=.02).
• Global circumferential strain rate increased (worsened) by 0.011/year (P=.01).
• No significant difference in the rate of functional change was observed between patients who met the composite endpoint and those who did not.

Conclusions:

• Global longitudinal and circumferential strain rates worsen over 10 years post-Fontan.
• These strain parameters may serve as early indicators of cardiac dysfunction.
• Worsening strain rates may precede more evident echocardiographic signs of deterioration.